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Objective: The objective of this study was to develop the first Moroccan recommendations concerning nutrition in patients with osteosarcopenia. Material and methods: A steering committee consisting of rheumatologists and nutritionists drafted the initial version of the recommendations in light of the literature review and the recommendations of international societies. The draft was reviewed by a reading committee of 13 experts to approve the final version. Results: Four overarching principles and ten recommendations were established. The overarching principles emphasize that nutritional advice is not a substitute for the pharmacological treatment of osteosarcopenia. Instead, it should be based on scientific evidence and take into account the specific characteristics of Moroccan society. The recommendations emphasize the significance of adequate calcium and vitamin D intake while evaluating the benefit-risk ratio in instances where calcium supplementation is indicated. A balanced intake of trace elements, vitamins, proteins, and dairy products should be maintained. The Mediterranean diet is recommended, while vegetarian diets and restrictive diets in individuals who are not overweight are not advised. It is recommended that individuals who fast during Ramadan consume a varied and balanced diet. It is recommended that the consumption of soft drinks and alcohol be limited. The consumption of phytoestrogens from food in moderation is considered beneficial as part of a balanced diet. Nevertheless, the use of supplements is not advised. Conclusion: The purpose of this work is to provide Moroccan rheumatologists with a practical tool to improve the nutritional aspect in patients with osteosarcopenia. [ABSTRACT FROM AUTHOR]

Intravaginal rings (IVRs) are long-acting drug device systems designed for controlled drug release in the vagina. Commercially available IVRs employ a one-size-fits-all development approach, where all patients receive the same drug in similar doses and frequencies, allowing no space for dosage individualization for specific patients' needs. To allow flexibility for dosage individualization, this study explores the impact of infill-density on critical characteristics of personalized IVRs, manufactured using droplet deposition modeling three-dimensional (3D) printing technology. The model drug was dispersed on the surface of thermoplastic polyurethane pellets using an oil coating method. IVR infill-density ranged from 60 to 100 %. The compatibility of the drug and matrix was assessed using thermal and spectroscopic analyses. The IVRs were evaluated for weight, porosity, surface morphology, mechanical properties, and in vitro drug release. The results demonstrated high dimensional accuracy and uniformity of 3D-printed IVRs, indicating the robustness of the printing process. Increasing infill-density resulted in greater weight, storage modulus, Young's modulus, Shore hardness, and compression strength, while reducing the porosity of IVRs. All IVRs showed a controlled drug release pattern when tested under accelerated conditions of temperature for 25 days. Notably, greater infill-densities were associated with a decrease in the percentage of drug released. Overall, the study demonstrated that infill-density was an important parameter for personalizing the critical characteristics of the 3D-printed IVRs to fit individual patient needs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier B.V.)

Background and objective Secukinumab (SECU) is a biologic disease-modifying antirheumatic drug (bDMARD) that has demonstrated effectiveness against axial spondyloarthritis (ax-SpA). However, in clinical practice, secukinumab is most commonly used as a second-line treatment after failure of or intolerance to tumor necrosis factor inhibitors (TNFi). In this study, we aimed to compare the two-year drug retention between secukinumab and TNFi in biologic-naïve patients with ax-SpA, to estimate the remission/low disease activity (LDA) rates in both groups and assess the safety profiles. Methods This was a longitudinal observational study involving patients with ax-SpA who were biologic-naïve and were receiving SECU or TNFi between December 2019 and December 2021. The two-year therapeutic retention rate in both groups was determined. Remission and LDA rates obtained at 24 months according to the Ankylosing Spondylitis Disease Activity Score based on C-reactive protein (ASDAS-CRP) scale, as well as the safety profile, were compared between the two groups. Results Seventy-five patients were included in the study. Of them, 34.6% received SECU, while 65.3% received TNFi; 85.3% were males. The mean age was 37.8 ±9 years, the mean disease duration was 10.2 ±6.1 years, and the initial ASDAS-CRP was 3.5 ±0.8. At 24 months; the therapeutic retention rate was 70% for SECU and 66% for TNFi. The reasons for discontinuation were inefficacy (SECU: 11.5%, TNFi: 20.4%, p=0.33), side effects (SECU: 0, TNFi: 4.1%, p=0.29), and socioeconomic conditions (SECU: 15.5%, TNFi: 10.2%, p=0.51). The rate of patients achieving remission and LDA was comparable between the two groups: (remission - SECU: 23.1%, TNFi: 24.5%, p=0.92; LDA - SECU: 73.1%, TNFi: 73.5%, p=0.16). There was no statistically significant difference in the safety profile. Conclusions Our findings suggest that the effectiveness and safety of secukinumab for ax-SpA in biologic-naïve patients are comparable to those of TNFi., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committee for Biomedical Research Mohammed V University- Rabat issued approval 37/24. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Zemrani et al.)

Introduction Fibromyalgia (FM) is characterized by widespread pain and fatigue, accompanied by symptoms such as decreased concentration, autonomic dysfunction, and abdominal pain. It can be either primary or secondary, notably to rheumatoid arthritis (RA). The Fibromyalgia Assessment Screening Tools (FAST 4), derived from the Multidimensional Health Assessment Questionnaire (MDHAQ), is a composite tool allowing for the rapid screening of FM. Our primary objective is to determine the prevalence of FM among RA patients using the FAST 4 index. Secondary objectives include comparing the FAST 4 index with the FiRST score and describing the correlation between FM and RA activity and different factors associated with FM in RA patients. Methods This was an observational cross-sectional study including patients diagnosed with RA according to the ACR/EULAR criteria. The FAST questionnaire comprises four sections assessing pain and fatigue on a visual analog scale, painful joints reported by the patient, and a list of 60 symptoms. A FAST 4 score of ≥ 3/4 indicates a positive screening for FM. Demographics and disease features were compared using descriptive statistics. Univariate and multivariate analyses using logistic regression models were performed to calculate odds ratios (ORs) with 95% CI. The sensitivity and specificity of the FAST 4 index were evaluated, and Fagan's nomograms were used to illustrate post-test probability. Statistically significant results were considered for p-values less than 0.05. Results The study enrolled 97 patients diagnosed with RA. The mean age of the patients was 56 ± 12.7 years, with a predominance of females (90.7%, N=88). The mean duration of RA was 13.5 ± 8.69 years. RA activity measured by DAS 28-ESR showed that 40.2% (N=39) had high disease activity, 38.1% (N=37) had moderate disease activity, 11.3% (N=11) had low disease activity, and 10.3% (N=10) were in remission. The prevalence of comorbid FM, according to the FAST 4 index, was 30.9% (N=30). Based on the Multidimensional Health Assessment Questionnaire (MDHAQ), depression was observed in 66.7% (N=20) patients with FM, while anxiety was reported in 60% (N=18). Moreover, 30.4% of patients screened positive for FM using the FiRST score. The FAST 4 index detected FM patients defined by FiRST with a sensitivity of 78.6% and a specificity of 87.1%. The positive predictive value (PPV) was 73.3%, and the negative predictive value (NPV) was 90%. Univariate analysis revealed that a positive FAST 4 index was associated with the number of painful and swollen joints (p<0.001 and 0.03, respectively). Additionally, patients with a positive FAST 4 index showed higher DAS 28 scores (p=0.002). No significant association was found with CRP levels (p=0.328), ESR (p=0.499), or the use of biological treatments (p=0.146) or corticosteroids (p=0.940). In multivariate analysis, only depression remained a risk factor, increasing the risk sixfold with an OR of 5.917, 95% CI (1.91-18.3), p=0.002. Conclusion Our study suggests a high prevalence of concomitant FM in our population, highlighting the importance of screening for FM, particularly using the FAST 4 index based solely on the MDHAQ questionnaire., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Ethics Committee for Biomedical Research at Mohammed V University in Rabat, Faculty of Medicine and Pharmacy of Rabat issued approval CERB 61-24. The study protocol was reviewed and approved by local institutional review boards and the national ethics committee: the Ethics Committee for Biomedical Research at Mohammed V University in Rabat, Faculty of Medicine and Pharmacy of Rabat. The committee's reference number is CERB 61-24 The statement is available in PDF format. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, El-Kasmi et al.)