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BACKGROUND: Dyspnea is a subjective symptom of asthma whose perception is characterized by an interindividual variability. Poor dyspnea perception is usually associated with increased risk of exacerbation and may lead to inappropriate asthma management and under-treatment. We sought to identify factors associated with discrepancies between poor dyspnea perception and abnormal lung function in patients with moderate persistent asthma. METHODOLOGY: 65 patients, who attended their scheduled follow-up pulmonology consultation at Ibn Sina Hospital (Rabat - Morocco), underwent interrogation including modified Medical Research Council (mMRC) scale for dyspnea, physical examination and spirometry. Two groups, those with mMRC < 2 (poor dyspnea perceivers) and those with mMRC scale ≥ 2 were compared. RESULTS: Poor dyspnea perception was found in 21 patients (32.3%). Associated factors were male sex (p : 0.03), low socio-economic income (p : 0.01), an onset of symptoms greater than 10 years (p : 0.01), BMI ≥ 25 Kg/m2 (p : 0.04) and depression (p : 0.04). CONCLUSION: The results revealed factors significantly associated with poor dyspnea perception despite an obstructive ventilatory disorder. These factors could usefully be considered to successfully manage asthma as well as the regular prescription of an objective test like spirometry.

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INTRODUCTION: The use of blue light-emitting devices (smartphones, tablets, and laptops) at bedtime has negative effects on sleep due to light stimulation and/or problematic excessive use. We aimed to evaluate, among young medical students, if the perception of sleep disturbances due to bedtime use of these devices is consistent with healthier habits and a better sleep quality. MATERIALS AND METHODS: 294 medical students in medicine and pharmacy from the Faculty of Medicine and Pharmacy of Rabat, Morocco, took part in this anonymous and voluntary cross-sectional study and answered an electronic questionnaire. Student and Mann-Whitney U tests were used to compare variables between 2 groups based on their perception of sleep disturbances. The level of significance was p ≤ 0.05. RESULTS: 286 students (97.3%) used a blue light-emitting smart device at bedtime before sleep, and sleep quality was poor (Pittsburgh Sleep Quality Index, PSQI > 5) in 101 students (35.3%). The perception of sleep disturbances due to this night usage was reported by 188 of them (65.7%). In this group, 154 (81.9%) used their device with all the lights turned off in the room (p=0.02), 34 (18.1%) put devices under pillows (p=0.04), 114 (60.6%) interrupted sleep to check messages (p < 0.001), and the mean duration use of these technologies at bedtime was 2 h ± 23 min per night (p=0.02). Also, the mean sleep duration was 6.3 hours ± 1.25 (p=0.04), 119 (63.3%) presented fatigue on waking more than one time per week (p=0.04), and 76 (40.4%) presented poor sleep quality (75.2% of the students with PSQI > 5) (p=0.005). CONCLUSIONS: Despite the perception of sleep disturbances due to bedtime use of blue light-emitting devices, unhealthy sleep habits tend to be frequent in young medical students and worrying because it is associated to significant poor sleep quality.

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Purpose: Poor quality of sleep and excessive daytime sleepiness affect cognitive ability and have a negative impact on the academic performance of medical students. This study aims to determine the prevalence of excessive daytime sleepiness, sleep quality and psychological distress as well as assess their association with low academic performance in this population. Participants and methods: A cross-sectional study was conducted among 457 medical students from the Faculty of Medicine and Pharmacy of Rabat, Morocco, who completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire and the Epworth Sleepiness Scale to determine the quality of sleep and excessive daytime sleepiness, respectively. Sociodemographic variables and psychological distress (Kessler Psychological Distress Scale) were also measured. Multivariate linear regression was performed in order to evaluate the link between low academic performance and sleep quality after adjusting for other covariates. Results: Among the included students, the median age was 20 (19; 21) years; 70.7% of the participants were females. Almost one-third of the students (36.6%) had excessive daytime sleepiness and this was more frequently observed in female students (43% vs 20.1%, <0.001). Furthermore, 58.2% of the students were poor sleepers (PSQI ≥5), while 86.4% of them had psychological distress. The bivariate analysis showed that psychological distress was associated with decreased risk of low performance (ß=0.04; 95% CI=0.005-0.07; P=0.024). Being a poor sleeper was statistically associated with poor academic performance (ß= -0.07; 95% CI=-0.14 to -0.002; P=0.04) in the multivariate analysis. In our study, daytime sleepiness was not statistically associated with academic performance. Conclusion: A poor sleep quality determined by PSQI ≥5 was related to poor academic achievement at the end of the study year in medical students.

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INTRODUCTION: Sleep apnea syndrome is increasingly common in the general population and is under-diagnosed but we lack studies on the estimation of its specific prevalence in several populations including Morocco. MATERIALS AND METHODS: The aim of the study is to determine the prevalence of the main clinical symptoms of sleep apnea syndrome including snoring, witnessed apnea and excessive daytime sleepiness in a middle aged Moroccan population through an epidemiological investigation in 288 men and 215 women, aged between 21 to 66 years who completed two self-questionnaires: the Berlin questionnaire to assess sleep and the Epworth scale to assess daytime sleepiness. RESULTS: The mean age was 42.7 years ± 14.3. The Epworth Sleepiness Scale was on average 6.9 ± 3.4 (range: 1-16). It was above 10 in 21.7% in favor of excessive daytime sleepiness. The prevalence of snoring and apnea was respectively 54.7% and 11.1% in the general population, 63.9% and 13.9% in men, 42.3% and 7.4% in women. Forty eight subjects (9.5%) including 13 women and 35 men had the combination of these three main clinical signs suggestive of sleep apnea syndrome. This subpopulation was older (p= 0.04) and with more overweight (p= 0.03) than the general population. Hypertension rate was not statistically higher in this subgroup. CONCLUSION: Prevalence of the main symptoms of sleep apnea syndrome is high in our study (9.5%). Polygraphy or polysomnography is warranted to diagnose and have an exact prevalence in the Moroccan population.

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INTRODUCTION: Sleep apnea syndrome is a highly prevalent disorder that is still underdiagnosed and undertreated and whose obstructive form is the most common. The diagnosis is suspected on clinical signs collected by interrogation and questionnaires (Berlin questionnaire and Epworth sleepiness scale), then confirmed by objective sleep study findings (polygraphy or polysomnography). It is necessary to conduct studies in each context on the characteristics and management of sleep apnea syndrome comprising the testing of reliability of the questionnaires. METHODS: Prospective and descriptive study of 104 patients addressed to sleep consultation at pulmononology Department of Ibn Sina Hospital, Morocco over a period of 5 years (January 2006 to December 2010), agreed to participate in the study, responded to a predetermined questionnaire, and benefited from clinical examination and paraclinical tests including a polygraphy or a polysomnography RESULTS: 59(56.7%) patients had an obstructive sleep apnea-hypopnea syndrome with a similar prevalence in both sexes. 32.2% of patients were obese and 28,8% had cardio-vascular diseases. Snoring, excessive daytime sleepiness and witnessed apnea were found in respectively 79.7%, 50.8% and 16.9%. Berlin questionnaire and Epworth sleepiness scale had an acceptable internal consistency against apnea hypopnea index with a Cronbach's alpha coefficient respectively 0.79 and 0.78. Depending on severity, clinical impact and results of investigations, the adequate treatment has been proposed based on the 2010 recommendations for clinical practice. CONCLUSION: This study has provided an idea about the profile and the management of patients having an obstructive sleep apnea-hypopnea syndrome and showed that both Berlin questionnaire and Epworth sleepiness scale are two simple and reliable methods in our context. A larger and further study across the country should be considered.

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Tuberculosis remains a public health concern worldwide particularly in Third World countries. Lymph node (LN) tuberculosis is the most frequent extra lung localization. Because of modern transport and mass migration from the developing to the developed world, it is important for all clinicians to keep this diagnostic possibility in mind. Evaluate demographic characteristics, diagnosis approaches, therapeutic strategies and evolutionary aspects while treatment in patients with confirmed LN tuberculosis. Data were retrospectively analyzed in 69 patients collected in 2 health centers in Rabat over a period of 4 years. There was a female (70%) and a young age predominance of patients (31.4 year +/-13.1). The median duration between the onset of symptoms and diagnosis was long: 115 days (interquartile range 34-150 days) explicated by low Socioeconomic conditions (p< 0.05). The cervical LN were most frequently involved (85.5%). The confirmation was histological in 98.5%, bacterial in the liquid from puncture LN in 1.5% of cases. 48% of patients had received treatment according to the national guide of tuberculosis. Half of the patients had received prolonged treatment on average of 7 months and a half (7.3 month +/-1.3) because of the paradoxical response (PR) (p< 0.05). At the end of treatment, LN had returned to their normal size in 80% of patients, we noted residual nodes in 11.6%, and a scrofula in 8.6%. The delay of diagnosis of LN tuberculosis is still important, and the treatment is prolonged because of PR.

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