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Marrakesh, Morocco

Jeremic B.,Stellenbosch University | Vanderpuye V.,National Center for Radiotherapy | Abdel-Wahab S.,Ain Shams University | Gaye P.,Institute Of Curie | And 14 more authors.
Clinical Oncology

Aims: To investigate patterns of practice in palliative radiotherapy in Africa. Materials and methods: Fifteen centres in Africa provided detailed information about radiotherapy in both metastatic and locally advanced disease via a questionnaire. Information included general information (institution status, equipment, staff, patient number), radiotherapy and other treatment characteristics in bone metastasis, brain metastasis, metastatic spinal cord compression, lung and liver metastasis, as well as locally advanced tumours. Results: The number of patients annually seen/treated ranged from 285 to 5000. Breast, cervix, head and neck, gastrointestinal and prostate cancer were the top five cancers overall. Eight (53%) institutions were without linear accelerators, four (27%) had a single one, whereas one institution each had two, three and four linear accelerators. The number of cobalt machines ranged from 0 to 2 (median 1). Most centres still prefer to use fractionated radiotherapy regimens over single-fraction regimens in bone metastasis, although most centres are now using single-fraction radiotherapy in retreatments. Radiotherapy in brain metastasis and metastatic spinal cord compression mostly conform to worldwide standards. Lung and liver metastases are rarely irradiated, largely as a consequence of the lack of modern radiotherapy technology. Locally advanced disease in various tumour sites was mostly palliated, in agreement with current evidence-based practices. Conclusions: African countries still lack adequate staffing and equipment to adequately address their clinical burden, being palliative in most cases. Emphasis should also be made on more rationally using existing capacities by using more of the single-fraction radiotherapy regimens, especially in bone metastasis. © 2014 The Royal College of Radiologists. Source

Lkhoyaali S.,National Oncology Institute | Benhmida S.,National Oncology Institute | Aitelhaj M.,National Oncology Institute | Layachi M.,National Oncology Institute | And 3 more authors.
Current Angiogenesis

Thyroid cancers are characterized by a good prognosis but 10 to 15% of patients progress and become refractory to current therapies. Systemic treatment based on chemotherapy in these settings has shown limited efficacy, with response rates not exceeding 25%. At progression, differentiated thyroid cancer is characterized by a high level of expression of vascular endothelial growth factor (VEGF). This high expression of VEGF is associated with an aggressive tumor behavior and a poor clinical outcome. We will review the recent advances in targeting angiogenesis in the treatment of recurrent and metastatic thyroid carcinoma. © 2014 Bentham Science Publishers. Source

Angiogenesis is an important step in breast cancer (BC) growth and progression. Targeting angiogenesis was the most interesting by developed strategy in the treatment of HER2-negative BC. Bevacizumab is a monoclonal humanized antibody targeting the vascular endothelial growth factor (VEGF) the most potent factor implicated in tumor angiogenesis. It is the most developed targeted agent in HER2-negative MBC and showed the most interesting results in combination with chemotherapy. Currently, bevacizumab is the only approved targeted therapy (in Europe only) in the first line treatment of HER2-negative metastatic BC in combination with weekly paclitaxel. The aim of the present paper is to review the role of anti-angiogenic agents (targeted agents only) in the treatment of HER2-negative metastatic BC. © 2014 Bentham Science Publishers. Source

Chadli A.,Ibn Rushd University Hospital | El Aziz S.,Ibn Rushd University Hospital | El Ansari N.,Mohammed University Hospital | Ajdi F.,Hassan II University | And 3 more authors.
Therapeutic Advances in Endocrinology and Metabolism

Objectives: The International Diabetes Mellitus Practice Study (IDMPS) is a 5-year survey documenting changes in diabetes treatment practices in developing countries. The primary objective of this survey was to assess the therapeutic management of type 2 diabetes mellitus (T2DM) in real-life medical practice. The secondary objectives were to evaluate the clinical management of type 1 diabetes mellitus (T1DM) and to assess the proportion of all diabetic patients failing to reach the glycated haemoglobin (HbA1c) <7% target. Methods: Data were analysed for 738 patients (240 with T1DM and 498 with T2DM) included in wave 5 of the IDMPS in Morocco in 2011. Results: Nearly two-thirds (61%) of T2DM patients were treated with oral glucose-lowering drugs (OGLDs) alone, 13.1% were treated with insulin alone and 23.3% were treated with OGLDs plus insulin. Insulin use was less frequent, was initiated later and involved a greater use of premixes versus basal/prandial schedules compared to other populations evaluated in the IDMPS. The majority (92.5%) of T1DM patients were treated with insulin alone and the remainder received insulin plus an OGLD. Insulin protocols included basal + prandial dosing (37.5%) and premix preparations (41.3%). The recommended target of HbA1c <7% was achieved by only 22.2% of T1DM patients and 26.8% of T2DM patients. More macrovascular but fewer microvascular complications were reported in T2DM compared to T1DM patients. Late complications increased with disease duration so that 20 years after diagnosis, 75.7% of T2DM patients were found to have at least one late complication. Conclusions: The clinical burden of diabetes is high in Morocco and the majority of patients do not achieve the recommended glycaemia target, suggesting that there is a huge gap between evidence-based diabetic management and real-life practice. Better education of patients and improved compliance with international recommendations are necessary to deliver a better quality of diabetic care. © The Author(s), 2016. Source

Herter-Aeberli I.,ETH Zurich | Cherkaoui M.,Cadi Ayyad University | El Ansari N.,University Cady Ayyad | El Ansari N.,Mohammed University Hospital | And 8 more authors.
Journal of Nutrition

Background: In iodine deficiency, thyrotropin (TSH) may increase to stimulate thyroidal iodine uptake. In iodine-sufficient populations, higher TSH predicts higher total cholesterol. Whether higher TSH caused by iodine deficiency affects serum lipids is uncertain. Objective: Our aim was to determine if iodine repletion decreases serum TSH and improves the lipid profile. Methods: In this randomized controlled intervention, iodine-deficient, overweight or obese Moroccan women (n = 163) received 200 μg oral iodine or a placebo daily for 6 mo. Main outcomes were serum TSH and plasma total and LDL cholesterol. Secondary outcomes included thyroid hormones and measures of lipid and glucose metabolism and urinary iodine concentration (UIC). Data were compared by using mixed-model analysis. Results: In the intervention group, median UIC increased from 38 (95% CI: 34, 45) μg/L to 77 (95% CI: 59, 89) μg/L (P < 0.001). After 6 mo of intervention, TSH was 33% lower in the treatment group than in the placebo group (P = 0.024). The triiodothyronine (T3) to thyroxine (T4) ratio and thyroglobulin decreased with treatment [-15% (P = 0.002) and -32% (P < 0.001), respectively], whereas T4 concentrations were higher in the treatment group (P < 0.001). Total cholesterol in subjects with elevated baseline cholesterol (>5 mmol/L) was reduced by 11% after the intervention (P = 0.034). At 6 mo, only 21.5% of treated women remained hypercholesterolemic (total cholesterol >5 mmol/L) vs. 34.8% of controls (baseline: 44.2% in the intervention and 36.8% in the control group; P = 0.015). The reduction in the prevalence of elevated LDL cholesterol (>3 mmol/L) in the intervention group (50.6% to 35.4% compared with 47.4% to 44.9% in the control group) was not significant (P-interaction = 0.23). Conclusions: Our findings suggest that moderate to severe iodine deficiency in overweight women elevates serum TSH and produces a more atherogenic lipid profile and that iodine supplementation in this group reduces the prevalence of hypercholesterolemia. Thus, iodine prophylaxis may reduce cardiovascular disease risk in overweight adults. Source

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