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Article: An unorthodox pathophysiology of severe cases of COVID-19 the weak heme hypothesis.

Zamd, Mohamed / Mtioui, Naoufal / Maoujoud, Omar / Ramdani, Benyounes

2020 Volume 10, Issue 6, Page(s) 305–310

Abstract: Important amount of severe cases is the main concern in COVID-19 pandemic. It could be the running cause of the burn out of the health system in many countries. The aim of this paper is to suggest a pathophysiologic hypothesis to explain the main ... ...

Abstract	Important amount of severe cases is the main concern in COVID-19 pandemic. It could be the running cause of the burn out of the health system in many countries. The aim of this paper is to suggest a pathophysiologic hypothesis to explain the main characteristics of severe cases of COVID-19 and its underlying conditions. In fact, the clinical and biological picture of severe cases of COVID-19 can easily be explained by free heme toxicity exceeding the endogenous antioxidant systems. Severe cases of COVID-19 are comparable to acute porphyria. On the other hand, the geographical distribution of severe cases of COVID-19 is directly associated to how fresh or polluted the air is. Finally, the relatively low rate of severe cases of COVID-19 could be explained by the presence of an unstable hemoglobin variant highly sensitive to the intrinsic conditions resulting from the acute pneumonia secondary to SARS-CoV2 infection. The combination of air pollution and free heme toxicity, resulting from the interaction between an unstable hemoglobin variant and SARS-CoV2 infection, seems to be the best scheme to explain clinical and biological manifestations in severe COVID-19. The arguments to support this hypothesis are detailed. We also propose some strategies to verify the concordance of our hypothesis with the reality and the implications it could have, if verified, either for scientists and decision makers.
Language	English
Publishing date	2020-12-15
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2620435-6
ISSN	2160-1992
ISSN	2160-1992
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Article: Mucocutaneous Manifestations in Kidney Transplant Patients: Risk Factors.

El Arabi, Yasmina / Hali, Fouzia / Mahdar, Yasmine / Zahid, Sophia / Zamd, Mohamed Ali / Chiheb, Soumiya / Ramdani, Benyounes

Cureus

2023 Volume 15, Issue 3, Page(s) e36177

Abstract: Introduction Mucocutaneous complications in kidney transplant patients are due to drug toxicity or immunosuppression. The main objective of our study was to determine the risk factors associated with their occurrence. Methods We conducted a prospective ... ...

Abstract	Introduction Mucocutaneous complications in kidney transplant patients are due to drug toxicity or immunosuppression. The main objective of our study was to determine the risk factors associated with their occurrence. Methods We conducted a prospective analytical study (January 2020- June 2021) including kidney transplant patients seen at the Nephrology Department. We described the characteristics of the patients who presented mucocutaneous complications and then compared them to those who didn't to deduce the risk factors. Statistical analysis was performed using SPSS 20.0 (p<0.05). Results Of the 86 patients recruited, thirty patients had mucocutaneous complications. The mean age was 42.73, with a male predominance (73%). Ten kidney transplants were performed from a living-related donor. All the patients received corticosteroids, Mycophenolate Mofetil, and the Calcineurin Inhibitor: Tacrolimus (76.7%) or Ciclosporin (23.3%). Induction was performed with Thymoglobulin (n=20) or Basiliximab (n=10). Mucocutaneous complications were dominated by infectious manifestations (53.4%): eight cases of fungal infections; six cases of viral infections: warts (n=3), herpes labialis (n=2), intercostal herpes zoster (n=1), and two cases of bacterial infections: atypical mycobacteria and boils. Inflammatory complications (36.6%) included acne (n=4), urticaria (n=3), rosacea (n=1), simple maculopapular exanthema (n=1), aphthous lesion (n=1), and black hairy tongue (n=1). Actinic keratosis, skin xerosis, and bruises were found in one patient respectively. The evolution with a symptomatic treatment was good in all the patients. After statistical analysis, the factors significantly associated with the occurrence of mucocutaneous complications were advanced age, male gender, anemia, HLA non-identical donor, as well as the use of Tacrolimus or Thymoglobulin. Conclusion Infectious mucocutaneous complications are the most common dermatological manifestations among renal transplant recipients. Their occurrence is related to advanced age, male gender, anemia, HLA non-identical donor, and the use of Tacrolimus or Thymoglobulin.
Language	English
Publishing date	2023-03-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.36177
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Book ; Online: An « unorthodox » pathophysiology of severe cases of COVID-19 The « weak heme » hypothesis

ZAMD, Mohamed / Chkairi, Naoufal Mtioui / Ramdani, Benyounès

2020

Abstract	Important amount of severe cases is the main concern in COVID-19 pandemic. It could be the running cause of the burn out of the health system in many countries. The aim of this paper is to suggest a pathophysiologic hypothesis to explain the main characteristics of severe cases of COVID-19 and its underlying conditions. In fact, the clinical and biological picture of severe cases of COVID-19 can easily be explained by free heme toxicity exceeding the endogenous antioxidant systems. Severe cases of COVID-19 are comparable to acute porphyria. On the other hand, the geographical distribution of severe cases of COVID-19 is directly associated to how fresh or polluted the air is. Finally, the relatively low rate of severe cases of COVID-19 could be explained by the presence of an unstable hemoglobin variant highly sensitive to the intrinsic conditions resulting from the acute pneumonia secondary to SARS-CoV2 infection. The combination of air pollution and free heme toxicity, resulting from the interaction between an unstable hemoglobin variant and SARS-CoV2 infection, seems to be the best scheme to explain clinical and biological manifestations in severe COVID-19. The arguments to support this hypothesis are detailed. We also propose some strategies to verify the concordance of our hypothesis with the reality and the implications it could have, if verified, either for scientists and decision makers.
Keywords	covid19
Publisher	Center for Open Science
Publishing country	us
Document type	Book ; Online
DOI	10.31219/osf.io/tn24g
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Article ; Online: Carbon footprint of a hemodialysis unit in Morocco.

Mtioui, Naoufal / Zamd, Mohamed / Ait Taleb, Abdellah / Bouaalam, Abdellah / Ramdani, Benyounes

Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy

2020 Volume 25, Issue 5, Page(s) 613–620

Abstract: Climate changes have a major influence on the overall health of the population. They are directly linked to the emissions of the greenhouse gases (GHG). The extent of GHG emission in relation to hemodialysis has been measured by several studies all over ... ...

Abstract	Climate changes have a major influence on the overall health of the population. They are directly linked to the emissions of the greenhouse gases (GHG). The extent of GHG emission in relation to hemodialysis has been measured by several studies all over the world. Up to this date, no similar study has been conducted in Morocco. Therefore, the objective of our study is to conduct a review of the GHG emissions and to evaluate its specificities in order to establish a targeted action plan to reduce the ecological impact of hemodialysis in Morocco. To do this, we sought the help of a certified audit firm. Carbon Footprint tool (L'outil Bilan Carbon), established in Morocco in collaboration with Mohammed VI Foundation for the Protection of the Environment, was used to analyze the results collected for the year 2019. Our unit (conventional hemodialysis 3 × 4 hours, 424 m
MeSH term(s)	Carbon Footprint/statistics & numerical data ; Greenhouse Gases/analysis ; Hemodialysis Units, Hospital ; Humans ; Morocco ; Renal Dialysis
Chemical Substances	Greenhouse Gases
Language	English
Publishing date	2020-12-14
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2119809-3
ISSN	1744-9987 ; 1091-6660 ; 1744-9979
ISSN (online)	1744-9987
ISSN	1091-6660 ; 1744-9979
DOI	10.1111/1744-9987.13607
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Article ; Online: Why overestimate or underestimate chronic kidney disease when correct estimation is possible?

De Broe, Marc E / Gharbi, Mohamed Benghanem / Zamd, Mohamed / Elseviers, Monique

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

2017 Volume 32, Issue suppl_2, Page(s) ii136–ii141

Abstract: There is no doubt that the introduction of the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines 14 years ago, and their subsequent updates, have substantially contributed to the early detection of different stages of chronic kidney disease ( ... ...

Abstract	There is no doubt that the introduction of the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines 14 years ago, and their subsequent updates, have substantially contributed to the early detection of different stages of chronic kidney disease (CKD). Several recent studies from different parts of the world mention a CKD prevalence of 8-13%. However, some editorials and reviews have begun to describe the weaknesses of a substantial number of studies. Maremar (maladies rénales chroniques au Maroc) is a recently published prevalence study of CKD, hypertension, diabetes and obesity in a randomized, representative and high response rate (85%) sample of the adult population of Morocco that strictly applied the KDIGO guidelines. When adjusted to the actual adult population of Morocco (2015), a rather low prevalence of CKD (2.9%) was found. Several reasons for this low prevalence were identified; the tagine-like population pyramid of the Maremar population was a factor, but even more important were the confirmation of proteinuria found at first screening and the proof of chronicity of decreased estimated glomerular filtration rate (eGFR), eliminating false positive results. In addition, it was found that when an arbitrary single threshold of eGFR (<60 mL/min/1.73 m2) was used to classify CKD stages 3, 4 and 5, it lead to substantial 'overdiagnosis' (false positives) in the elderly (>55 years of age), particularly in those without proteinuria, haematuria or hypertension. It also resulted in a significant 'underdiagnosis' (false negatives) in younger individuals with an eGFR >60 mL/min/1.73 m2 and below the third percentile of their age-/gender-category. The use of the third percentile eGFR level as a cut-off, based on age-gender-specific reference values of eGFR, allows the detection of these false positives and negatives. There is an urgent need for additional quality studies of the prevalence of CKD using the recent KDIGO guidelines in the correct way, to avoid overestimation of the true disease state of CKD by ≥50% with potentially dramatic consequences.
MeSH term(s)	Adult ; Aged ; Belgium/epidemiology ; Diagnostic Errors/prevention & control ; Early Diagnosis ; Female ; Glomerular Filtration Rate ; Humans ; Hypertension/physiopathology ; Kidney/physiopathology ; Male ; Middle Aged ; Obesity/physiopathology ; Prevalence ; Proteinuria/epidemiology ; Renal Insufficiency, Chronic/classification ; Renal Insufficiency, Chronic/diagnosis ; Renal Insufficiency, Chronic/epidemiology ; Terminology as Topic
Language	English
Publishing date	2017-04-01
Publishing country	England
Document type	Journal Article
ZDB-ID	90594-x
ISSN	1460-2385 ; 0931-0509
ISSN (online)	1460-2385
ISSN	0931-0509
DOI	10.1093/ndt/gfw267
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Article: Management of pain at arteriovenous fistula puncture: Cryotherapy versus lidocaine/prilocaine.

Kortobi, Loubna / Belymam, Hajar / Chkairi, Naoufal Mtioui / Zamd, Mohamed / Medkouri, Ghislaine / Gharbi, Mohammed Benghanem / Ramdani, Benyounes / El Khayat, Selma Siham

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia

2020 Volume 31, Issue 3, Page(s) 597–603

Abstract: Pain at arteriovenous fistula (AVF) puncture is common in hemodialysis (HD) patients. The purpose of our work is to determine its frequency, to evaluate the efficiency of two techniques: anesthetic cream (Emla™) and cryotherapy, and to compare their ... ...

Abstract	Pain at arteriovenous fistula (AVF) puncture is common in hemodialysis (HD) patients. The purpose of our work is to determine its frequency, to evaluate the efficiency of two techniques: anesthetic cream (Emla™) and cryotherapy, and to compare their efficiency. A prospective and interventional analytical study of HD patients was conducted in our structure. We included all patients with pain at AVF puncture. We evaluated the pain intensity using a visual analogue scale before and after our intervention: Emla™ cream during three consecutive HD sessions, then cryotherapy (ice cubes placed in latex gloves, during 5 min, directly applied on the puncture sites) during three consecutive HD sessions. The statistical analysis was performed using the Epi Info software. Eighty-four patients are undergoing HD in our structure, of which 32 (38%) report pain at AVF puncture. The mean value of the visual analog scale before the puncture was 7.19 ± 1.95 (4-10). Pain decrease was statistically significant for both techniques. Comparative analysis of the two techniques revealed a significant reduction in pain in favor of cryotherapy (P 0.001). The analgesic effect has been proved for both techniques. Cryotherapy provides higher efficiency, with fewer constraints, and could be proposed for the management of pain at AVF puncture.
MeSH term(s)	Adult ; Aged ; Anesthetics, Local/therapeutic use ; Arteriovenous Shunt, Surgical/adverse effects ; Cryotherapy ; Female ; Humans ; Lidocaine/therapeutic use ; Male ; Middle Aged ; Pain, Procedural/therapy ; Prilocaine/therapeutic use ; Prospective Studies ; Punctures/adverse effects ; Young Adult
Chemical Substances	Anesthetics, Local ; Prilocaine (046O35D44R) ; Lidocaine (98PI200987)
Language	English
Publishing date	2020-07-23
Publishing country	Saudi Arabia
Document type	Journal Article
ZDB-ID	1379955-1
ISSN	1319-2442
ISSN	1319-2442
DOI	10.4103/1319-2442.289446
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Article ; Online: Management of pain at arteriovenous fistula puncture

Loubna Kortobi / Hajar Belymam / Naoufal Mtioui Chkairi / Mohamed Zamd / Ghislaine Medkouri / Mohammed Benghanem Gharbi / Benyounes Ramdani / Selma Siham El Khayat

Saudi Journal of Kidney Diseases and Transplantation, Vol 31, Iss 3, Pp 597-

Cryotherapy versus lidocaine/prilocaine

2020 Volume 603

Abstract	Pain at arteriovenous fistula (AVF) puncture is common in hemodialysis (HD) patients. The purpose of our work is to determine its frequency, to evaluate the efficiency of two techniques: anesthetic cream (Emla™) and cryotherapy, and to compare their efficiency. A prospective and interventional analytical study of HD patients was conducted in our structure. We included all patients with pain at AVF puncture. We evaluated the pain intensity using a visual analogue scale before and after our intervention: Emla™ cream during three consecutive HD sessions, then cryotherapy (ice cubes placed in latex gloves, during 5 min, directly applied on the puncture sites) during three consecutive HD sessions. The statistical analysis was performed using the Epi Info software. Eighty-four patients are undergoing HD in our structure, of which 32 (38%) report pain at AVF puncture. The mean value of the visual analog scale before the puncture was 7.19 ± 1.95 (4-10). Pain decrease was statistically significant for both techniques. Comparative analysis of the two techniques revealed a significant reduction in pain in favor of cryotherapy (P 0.001). The analgesic effect has been proved for both techniques. Cryotherapy provides higher efficiency, with fewer constraints, and could be proposed for the management of pain at AVF puncture.
Keywords	Medicine ; R
Subject code	616
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Wolters Kluwer Medknow Publications
Document type	Article ; Online
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Article ; Online: Autodialysis in Morocco: how much longer can we wait?

Noto-Kadou-Kaza, Béfa / Mahamat, Hissein Ali / Mtioui, Naoufal / Izem, Amina / Abouamrane, Lalla Meryam / El-Khayat, Selma / Zamd, Mohamed / Medkouri, Ghislaine / Benghanem, Mohamed Gharbi / Ramdani, Benyounes

The Pan African medical journal

2019 Volume 33, Page(s) 162

Abstract: Introduction: Autodialysis is the dialysis performed by the patient himself at a local center instead of a hemodialysis center. In Morocco, the practice of hemodialysis dates back to 1970; however, an autodialysis center does not yet exist. The ... ...

Abstract	Introduction: Autodialysis is the dialysis performed by the patient himself at a local center instead of a hemodialysis center. In Morocco, the practice of hemodialysis dates back to 1970; however, an autodialysis center does not yet exist. The objective was to assess the potential medical fitness and adherence of the patients to an autodialysis program. Methods: Descriptive and analytical multicenter study conducted in March 2015 involving patients from of eight hemodialysis centers in Casablanca (Morocco). The study was conducted in two steps: 1) a transversal assessment of the medical potential to achieve autodialysis that included 556 patients; 2) a survey of the autodialysis membership that included 383 out of 556 patients who were deemed eligible for autodialysis. Results: The average age was 54.63 ± 15.16 years; the average of hemodialysis duration was 85.9 ± 78.1 months. Diabetic nephropathy (22.7%) was the predominant cause of kidney disease. The assessment of medical potential to achieve autodialysis highlighted that almost all of the patients were in good condition (93%), independent (81%), and those without major comorbidities were less than 76 years old. Regarding the potential patients' adherence to autodialysis, among the 383 patients previously deemed suited for autodialysis, 293 (76.5%) responded favorably to the proposal of self-dialysis. Conclusion: The practice of hemodialysis should be implemented in a short time in Morocco because our patients' profile is perfectly suitable to this therapeutic method especially when they are young, in good general condition, autonomous, without major comorbidities, and willing to learn.
MeSH term(s)	Adult ; Aged ; Diabetic Nephropathies/epidemiology ; Diabetic Nephropathies/therapy ; Female ; Humans ; Kidney Diseases/etiology ; Kidney Diseases/therapy ; Male ; Middle Aged ; Morocco ; Patient Compliance/statistics & numerical data ; Renal Dialysis/methods ; Self Care/methods
Language	English
Publishing date	2019-07-03
Publishing country	Uganda
Document type	Journal Article ; Multicenter Study
ZDB-ID	2514347-5
ISSN	1937-8688 ; 1937-8688
ISSN (online)	1937-8688
ISSN	1937-8688
DOI	10.11604/pamj.2019.33.162.13282
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Article ; Online: Autodialysis in Morocco

Béfa Noto-Kadou-Kaza / Hissein Ali Mahamat / Naoufal Mtioui / Amina Izem / Lalla Meryam Abouamrane / Selma El-Khayat / Mohamed Zamd / Ghislaine Medkouri / Mohamed Gharbi Benghanem / Benyounes Ramdani

The Pan African Medical Journal, Vol 33, Iss

how much longer can we wait?

2019 Volume 162

Abstract: INTRODUCTION: Autodialysis is the dialysis performed by the patient himself at a local center instead of a hemodialysis center. In Morocco, the practice of hemodialysis dates back to 1970; however, an autodialysis center does not yet exist. The objective ...

Abstract	INTRODUCTION: Autodialysis is the dialysis performed by the patient himself at a local center instead of a hemodialysis center. In Morocco, the practice of hemodialysis dates back to 1970; however, an autodialysis center does not yet exist. The objective was to assess the potential medical fitness and adherence of the patients to an autodialysis program. METHODS: descriptive and analytical multicenter study conducted in March 2015 involving patients from of eight hemodialysis centers in Casablanca (Morocco). The study was conducted in two steps: 1) a transversal assessment of the medical potential to achieve autodialysis that included 556 patients; 2) a survey of the autodialysis membership that included 383 out of 556 patients who were deemed eligible for autodialysis. RESULTS: the average age was 54.63 , 15.16 years; the average of hemodialysis duration was 85.9 , 78.1 months. Diabetic nephropathy (22.7%) was the predominant cause of kidney disease. The assessment of medical potential to achieve autodialysis highlighted that almost all of the patients were in good condition (93%), independent (81%), and those without major comorbidities were less than 76 years old. Regarding the potential patients' adherence to autodialysis, among the 383 patients previously deemed suited for autodialysis, 293 (76.5%) responded favorably to the proposal of self-dialysis. CONCLUSION: the practice of hemodialysis should be implemented in a short time in Morocco because our patients' profile is perfectly suitable to this therapeutic method especially when they are young, in good general condition, autonomous, without major comorbidities, and willing to learn.
Keywords	autodialysis ; auto-dialysis ; self-dialysis ; home hemodialysis ; dialysis ; dialysis accession ; renal replacement therapy (rrt) ; Medicine ; R
Subject code	616
Language	English
Publishing date	2019-07-01T00:00:00Z
Publisher	The Pan African Medical Journal
Document type	Article ; Online
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Article: Pulmonary hypertension: prevalence and risk factors.

Faqih, Samia Ait / Noto-Kadou-Kaza, Béfa / Abouamrane, Lalla Meryam / Mtiou, Naoufal / El Khayat, Selma / Zamd, Mohamed / Medkouri, Ghislaine / Benghanem, Mohamed Gharbi / Ramdani, Benyounes

International journal of cardiology. Heart & vasculature

2016 Volume 11, Page(s) 87–89

Abstract: Introduction: Pulmonary arterial hypertension (PAH), defined as a systolic pulmonary artery pressure above 35 mm Hg, is another vascular disease entity recently described in patients receiving hemodialysis. It is a major problem due to its high ... ...

Abstract	Introduction: Pulmonary arterial hypertension (PAH), defined as a systolic pulmonary artery pressure above 35 mm Hg, is another vascular disease entity recently described in patients receiving hemodialysis. It is a major problem due to its high prevalence and morbidity and mortality. Its pathophysiological mechanism is just known and the strategies for its supported not yet defined. Aims: To determine the prevalence of PAH in our hemodialysis patients and its risk factors. Methodology: Single center descriptive and analytical cross-sectional study, including 111 hemodialysis patients who had benefit from a trans-thoracic cardiac Doppler ultrasound during 2014. A value greater than or equal to 35 mm Hg is considered PAH and classified as follows: mild PAH (35 50 mm Hg), moderate PAH (50 70 mm Hg), and severe pulmonary hypertension (> 70 mm Hg). Patients with a high probability of secondary PAH, especially those with the following history: chronic obstructive pulmonary disease, pulmonary embolism, were not included. Results: The mean age was 44.3 ± 14.2 years. Among the 111 patients, 18 had pulmonary arterial pressure above 35 mm Hg corresponding to 16.22% of PAH prevalence. The average pressure was 45 mm Hg. Of these 18 patients, 11.8% had mild PAH, 3.4% moderate PAH and 0.8% severe PAH. The average hemodialysis duration was significantly associated with PAH (p = 0.003); as well as valvular calcification (p = 0.000), mitral regurgitation (p = 0.001) and tricuspid regurgitation (p = 0.002). Conclusion: Primary pulmonary hypertension is a major problem among our hemodialysis because of its high prevalence and its risk factors.
Language	English
Publishing date	2016-05-09
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	2818464-6
ISSN	2352-9067
ISSN	2352-9067
DOI	10.1016/j.ijcha.2016.05.012
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