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L’hépatite auto-immune : en l’absence de traitement, la maladie évolue vers la destruction du foie 1095

Dr Moussayer khadija, 1 y.
4 min read.
AVERTISSEMENT : article dont certains éléments sont plutôt réservés à un public averti L'hépatite auto-immune est une maladie dans laquelle le propre système immunitaire de l'organisme attaque le foie. La maladie est chronique et susceptible de durer des années. Si elle n'est pas traitée, elle peut causer une cirrhose et une insuffisance hépatique. Elle se caractérise par une cytolyse hépatique ('augmentation d'enzymes qui montrent la destruction d'hépatocytes), une hypergammaglobulinémie polyclonale (résultant d'une surexpression d'immunoglobulines due à une activation lymphocytaire B), la présence d’auto -anticorps sériques et par une infiltration lymphocytaire périportale. En l’absence de traitement, la maladie évolue vers la destruction du foie. Chez certains patients on peut observer des poussées qui peuvent être responsables d’une insuffisance hépatique aigüe. Il existe deux types d’hépatites auto-immunes, le type 1 diagnostiqué surtout chez l’adulte et caractérisé par la présence d’anticorps anti-muscle lisse, et le type 2 caractérisé par la présence d’anticorps anti-LKM1, surtout observé chez l’enfant. EPIDEMIOLOGIE L’HAI est une maladie rare : son incidence est estimée entre 2 et 4 /100 000 personnes par an. Elle représente moins de 6 % des hépatites chroniques en France. La prévalence varie selon un gradient nord-sud, il existe une fréquence plus élevée en Europe du Nord en relation à l’association avec l’haplotype HLA A1-B8-DR3. Des gènes de susceptibilité pour les maladies auto-immunes sont présents chez les patients et dans leur famille. A côté de l’atteinte hépatique, chez ces patients, il est fréquent d’observer d’autres maladies auto-immunes extra-hépatiques. La maladie peut débuter à tout âge, mais elle est particulièrement fréquente entre 10 et 30 ans et 40 à 50 ans. Elle touche à la fois les hommes et les femmes, mais il existe une nette prédominance féminine selon un ratio de 4 pour 1. En effet, les HAI touchent essentiellement la femme (70% des cas) et 50% des patientes affectées ont moins de 40 ans. Il existe également un pic d’incidence en période pré-pubertaire, à 10 ans pour le type 1 et à 6 ans et demi pour le type 2. La maladie est plus fréquente en phase pré-pubertaire et chez les filles. LES SYMPTOMES La présentation clinique est variable, près d’un tiers des patients atteints d’HAI 2T étant asymptomatiques, ce qui peut être à l’origine d’une reconnaissance tardive de la maladie, au stade de cirrhose dans 25% des cas. Ailleurs, on peut observer un ensemble de symptômes non spécifiques, tels que l'asthénie (85% des cas), un ictère (80%), une hépatomégalie (80%) ou des hépatalgies (50%). Dans environ 30% des cas, le mode de présentation est aigu et peut mimer un tableau d’hépatite virale. Plus rarement et en particulier dans les formes d’HAI-2 de l’enfant, la maladie peut se déclarer sous une forme sub-fulminante ou fulminante. Dans la moitié des cas, des manifestations dysimmunitaires extra-hépatiques telles que des arthralgies, une dysthyroïdie ou un diabète insulinodépendant peuvent être associés. La préobéit à 3 situations : · Des anomalies du bilan hépatique avec peu ou pas de symptômes. · Un tableau d’« hépatite aiguë » comprenant un ictère, des hépatalgies et des troubles digestifs. Ce mode de révélation concerne plus de la moitié des cas et ce début aigu pouvant aller jusqu'à l'hépatite fulminante. · Un atteinte hépatique chronique responsable d’une cirrhose installée à bas bruit : angiomes stellaires, érythrose palmaire, hippocratisme digital ou présence de signes d'hypertension portale (splénomégalie, ascite, hémorragie digestive...). DIAGNOSTIC La maladie doit être évoquée devant toute élévation des transaminases car la méconnaître peut comporter un risque d’évolution rapide vers la cirrhose, alors qu’un diagnostic précoce, compte tenu de l’efficacité des corticostéroïdes et des immunosuppresseurs, entraîne la guérison. L’enjeu du diagnostic est de différencier une origine virale d’une cause auto-immune de l’hépatite : le traitement par interféron d’une HAI peut être fatal ; il en est de même d’un traitement immunosuppresseur d’une hépatite virale. Le diagnostic repose sur les données de la biologie hépatique et la recherche des marqueurs. La biopsie du foie reste indispensable pour le diagnostic et pour la prise en charger. Aucun de ces éléments n’est spécifique et le diagnostic reste celui d’exclusion. Il convient d’éliminer d’autres diagnostics : hépatites virales, hépatites médicamenteuses, la maladie de Wilson, l’hémochromatose, le déficit en alpha1 antitrypsine. Dans les formes cholestatiques, il faut en particulier réaliser une cholangio-IRM (en l’absence d’anticorps antimitochondries). Chez environ 10 à 20% des malades, l’HAI est associée à une cholangite biliaire primitive réalisant un syndrome de chevauchement. TRAITEMENTS Il est fondé sur les corticoïdes et l'azathioprine. En seconde ligne, on peut utiliser le tacrolimus, le mycophénolate mofétil (MMF) ou encore des anticorps anti-CD20. Le MMF paraît très efficace en terme de réponses biologique et histologique chez des patients en rechute après l’association corticoïdes-azathioprine. La durée de traitement est de plusieurs années et 2 ans de biologie normale sont indispensables avant une décroissance ou un arrêt thérapeutique. L’acide ursodesoxycholique associée à la corticothérapie, apporte un bénéfice au moins biologique à des doses de 750 mg/j. Ce traitement est conseillé dans les formes frontière La transplantation hépatique est indiquée en cas d’hépatite (sub) fulminante résistant à un traitement à fortes doses par corticoïdes ou en cas de cirrhose accompagnée de complications sévères. L’hépatite auto-immune représente environ 5% des indications de transplantation pour cirrhose. Le taux de survie après transplantation est de 90% à cinq ans et de 75% à dix ans. La maladie peut récidiver jusque dans 40% des cas ; cette récidive, qui peut se manifester sous différentes formes (parfois sévères), serait favorisée par une immunosuppression insuffisante ou par un greffon présentant l’haplotype HLA DR3. Dr MOUSSAYER KHADIJA الدكتورة خديجة موسيار Spécialiste en médecine interne et en Gériatrie. Présidente de l’association marocaine des maladies auto-immunes et systémiques OVERVIEW Autoimmune hepatitis is liver inflammation that occurs when your body's immune system turns against liver cells. The exact cause of autoimmune hepatitis is unclear, but genetic and enviromental factors appear to interact over time in triggering the disease. Untreated autoimmune hepatitis can lead to scarring of the liver (cirrhosis) and eventually to liver failure. When diagnosed and treated early, however, autoimmune hepatitis often can be controlled with drugs that suppress the immune system. A liver transplant may be an option when autoimmune hepatitis doesn't respond to drug treatments or in cases of advanced liver disease.
Dr Moussayer khadija

Dr Moussayer khadija

Dr MOUSSAYER KHADIJA الدكتورة خديجة موسيار Spécialiste en médecine interne et en Gériatrie en libéral à Casablanca. Présidente de l’Alliance Maladies Rares Maroc (AMRM) et de l’association marocaine des maladies auto-immunes et systémiques (AMMAIS), Vice-présidente du Groupe de l’Auto-Immunité Marocain (GEAIM)


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The Polisario Front Confronted with Increasing Accusations: Moving Towards Being Designated as a Terrorist Organization 158

Aziz Daouda, 12 h.
For several years now, the Polisario Front, a separatist movement supported and armed, as everyone knows, by Algeria, which has provided it with an entire territory in the Tindouf area, has been at the center of a growing international controversy. In the United States, Japan, and Europe, voices are rising to have this group officially classified as a terrorist organization. This shift is based on tangible evidence of its links with actors qualified as terrorists, its involvement in violent actions, but also on a network of international alliances that go beyond the regional framework. While Algeria, Iran, and Hezbollah are often cited as the main supporters of the Polisario, as well as South Africa, Cuba has also played a historic and decisive role in the military and logistical training of separatist fighters. As early as 1977, under the impetus of Fidel Castro and at the request of Algeria, a tripartite military agreement was signed between Cuba, Algeria, and the Polisario, paving the way for intensive cooperation. This agreement allowed the sending of many separatist fighters to Cuba to receive specialized military training. Dedicated military schools were created on the island, where Polisario recruits were trained in guerrilla tactics, special operations, and military logistics. A Cuban delegation even went to Tindouf in 1988 to study Moroccan defenses and help develop strategies to breach the defense wall erected by the Kingdom. Cuba also provided naval logistical support, notably in the waters near the Canary Islands, where Cuban ships were involved in operations to facilitate Polisario infiltrations. Between 1975 and 1991, Cuba delivered to the Polisario a significant arsenal including assault rifles, mortars, rocket launchers, and ammunition, thus strengthening its military capabilities. Even after the 1991 ceasefire, Cuba maintained its support, continuing to train warriors especially in special operations. The last known class trained in Cuba dates back to 2003. More recently, six-month training courses have been given to groups of about forty separatists, focused on special forces tactics. Moreover, for a long period, damning testimonies report the kidnapping of children from the Tindouf camps, sometimes as young as 9 years old, to send them to Cuba on a "youth island" under high military surveillance. They undergo intensive military training mixed with strong political indoctrination. These children, isolated from their families, are trained to become soldiers in the service of the Polisario, under conditions denounced as inhumane by witnesses and former detainees. Some recent signals suggest a possible repositioning of Havana. Indeed, at the 2019 Non-Aligned Movement summit, Cuban President Miguel Díaz-Canel omitted any reference to the Polisario, marking a break with the tradition of support displayed by Fidel and Raúl Castro. This evolution could reflect a diplomatic realignment, notably after the resumption of diplomatic relations between Morocco and Cuba in 2017, relations broken for nearly 37 years due to Cuban support for the Polisario. However, to date, the aforementioned tripartite agreement has not yet been repealed. Cuba's role is part of a larger network of Polisario alliances. Algeria, the main political and military supporter, continues to arm and shelter the movement. Iran, through Hezbollah, provides military and logistical support, notably also training fighters and delivering sophisticated weapons. This is well documented. There are also hundreds of Polisario mercenaries captured in Syria, where they operated alongside Assad's army, reinforcing the image of a group involved in international terrorist conflicts. On the ground, the Polisario is also accused of violence against civilians in southern Morocco. The missiles launched against the city of Smara bear witness to this, in addition to the blockage of the strategic Guerguerat passage. The sequestration of Sahrawi populations in the Tindouf camps, where it refuses, with Algerian support, any official census, is another proof of the true nature of the movement. Faced with these elements, several American, European, and Asian political leaders advocate for the Polisario Front to be quickly listed as a terrorist organization. American Congressman Joe Wilson has proposed a bill to this effect, denouncing the use of the Polisario by Algeria and its accomplices to destabilize the Kingdom of Morocco, a long-standing strategic ally of the United States in the region. This eminent designation would deal a major blow to Algeria, which seems tireless in supporting the Polisario for nearly 50 years, while it simply costs the country development. It would further strengthen Morocco's position on the international stage, notably after the American recognition in 2020 of Moroccan sovereignty over its southern provinces, that of Spain, France, the recent one of the United Kingdom, and many other African and Latin American countries. The historical, military, and educational support of Cuba, combined with the role played by Algeria, Iran, and Hezbollah, places the Polisario in a network of actors with manifest destabilizing and terrorist activities. The rise in calls for its classification as a terrorist organization fits into a logic of regional and international security, requiring a coordinated response to restore stability in North Africa, the Sahel, and beyond. This page must be quickly turned for the good of the populations of the entire region

A Major Geopolitical Transformation in the Middle East 220

Aziz Daouda, 1 d.
The Middle East is undergoing a major geopolitical transformation, marked by a strategic realignment between Israel, the United States, and the Gulf powers. These latter, long marginalized from traditional alliances or subjected to them, are now asserting themselves as indispensable actors on the political, economic, and military stage, reshaping balances once considered historic and immutable. Since its creation in 1948, Israel has been the main Western ally in the Middle East, notably of the United States, which initially opposed its establishment, in a region marked by recurring conflicts. Its expansionist and influential policies, supported by Washington, have long crystallized tensions with several Arab countries and armed groups. However, this belligerent stance now seems contested, both by its neighbors and some of its traditional allies. In any case, it is widely disapproved of and even condemned by civil society everywhere. This cannot last. The most notable evolution in the region has come from the Gulf monarchies. After decades of hostility, they initiated a historic rapprochement with Israel, formalized by the Abraham Accords in 2020, under American impetus. These accords, signed notably by the United Arab Emirates and Bahrain, opened the way to strengthened cooperation, especially against Iranian influence, while fostering unprecedented economic and technological exchanges. The monarchies that did not sign these accords also have no qualms about dealing with Israel. Strong relations are also often mentioned between the Israeli state and Turkey, especially since it has been governed by Erdogan, a champion of Islamism. In this rapidly changing context, the United States has gradually reoriented its regional policy, focusing more on the Gulf monarchies, which offer political stability, financial power, and strategic positioning. The American military presence in the region, notably at the Al-Udeid base in Qatar, illustrates this new reality. During the 2025 American tour of the Middle East, nearly two trillion dollars in investments were announced, particularly in defense, technology, and artificial intelligence sectors. At the same time, Washington seems to adopt a more nuanced stance towards Israel, especially in the framework of negotiations with Iran, reflecting a diversification of regional alliances. Despite its military weight, Israel is gradually losing its exclusive influence, increasingly perceived as a source of tension. The current policies of Netanyahu’s cabinet, leading to a near-genocide in Gaza, do not help matters. Unlike previous decades, Arab countries, especially those in the Gulf, no longer systematically respond to Israeli provocations with force. Current leaders favor a pragmatic approach, now distinguishing the Palestinian cause from the actions of armed groups like Hamas. This evolution marks a turning point compared to the belligerent attitudes of past military regimes, which over time became de facto allies of the Zionist cause. Hassan II, a visionary, once said on this subject, "Hatred of Israel and the Jew is the most powerful aphrodisiac in the Arab-Muslim world." The Gulf monarchies, long proponents of a moderate discourse favorable to dialogue, are now imposing themselves as regional models of stability and cooperation with the West, as well as with Asian powers. Israel’s traditional role as the pivot of Western interests in the Middle East seems to be eroding in favor of a dynamic where Gulf monarchies take center stage. The multiplication of conflicts and the perception of an increasingly isolated Israel on the international stage—albeit mostly among populations—weakens its position. Europe, while hesitant, shows a hardening of tone towards Israeli actions, notably after recent incidents in the West Bank where diplomats were targeted by heavy fire from the Israeli army. This change in attitude can only strengthen the legitimacy of the Gulf monarchies as reliable partners for the West, as guarantors of regional stability and calm. The recent organization of a global conference on the Palestinian issue in Morocco, a signatory of the Abraham Accords and co-chaired by the Netherlands, illustrates this new dynamic. It is worth noting again that Morocco is a strategic ally of the Gulf monarchies, linked by multiple agreements, including defense. The words of Moroccan Foreign Minister Nacer Bourita are clear about the need to condemn all extremisms—implicitly Hamas extremism but also that of the current Israeli government. This discourse symbolizes hope for political renewal in the region, emphasizing respect for international law and the only possible solution: two states living side by side. This is also the position of France, whose president no longer hesitates to speak of recognizing the Palestinian state, making it a key element in his discussions during his many foreign visits. Addicted to blood and violence, Netanyahu no longer hesitates to accuse President Macron of crusading against the Jewish state. Excuse me? The Israeli leader is deeply wounded and has no plausible argument except to hide behind his own definition of antisemitism, which he throws around indiscriminately. It must be said that repeated American vetoes at the Security Council somewhat reinforce his delusion. Israel’s disproportionate reaction following the senseless Hamas attacks has become counterproductive for the Jewish state. As it seems to lose its role as the undisputed leader of Western interests in the region, the Gulf monarchies appear as the new stabilizers and promoters of peace in the Middle East. This geopolitical reshuffling could well redefine the balance of power in a region marked by incessant conflicts. The strong interconnection of the American economy with these countries, in light of the latest announced investments, will inscribe this emerging situation in a stable and likely lasting perspective. Israeli voters would do well to understand this quickly. At the next election, they should definitively rid themselves of these zealots who have only death on their lips and the extermination of a legitimate people as their goal.

Blind love 229

Boucharfou, 1 d.
Blind love To the one who looks at me and pretends not to see me While she is the source of my sorrows and setbacks Yet she confesses to others that she loves me who believes Leaning on her balcony every evening She doesn't care that I always be there at my perch Waiting for a signal from her, a hope To the one who looks at me and pretends not to see me While she is the source of my sorrows and my setbacks In spite I keep drinking And drinking get drunk every night Sitting in front of her window on the sidewalk To the one who looks at me and pretends not to see me While she is the source of my sorrows and my disappointments I say that this story is over now And that elsewhere I will go to see Dr Bouchareb Fouad July 5, 2022 Inspired by a piece of Andalusian music All rights reserved