Think Forward.

GERIATRIE : LA NUTRITION FACE AU VIEILLISSEMENT PHYSIOLOGIQUE DES PERSONNES ÂGÉES - PARTIE 1 2446

«QUAND ON AVANCE EN ÂGE, MIEUX VIVRE C’EST MIEUX SE NOURIR» L’équilibre nutritionnel de la personne âgée (PA) est plus précaire car tributaire de modifications physiologiques et de l’émergence de pathologies. Les personnes âgées ont tendance par ailleurs à diminuer leur apport alimentaire sans que leurs besoins énergétiques ne soient réduits : leurs réserves étant amoindries, tout incident rompt un équilibre déjà précaire et la dénutrition fait son apparition. L'IMPACT DU VIELLISSEMENT PHYSIOLOGIQUE SUR LA NUTRITION Avec l’âge, l’altération des perceptions des odeurs et du goût stimule moins l’appétit : la capacité discriminative s’affaiblit d’où une difficulté à identifier les aliments ; le seuil de détection des 4 saveurs de base augmente (multiplié par 11,6 pour le salé, 7 pour l’amer, 4,3 pour l’acide et 2,7 pour le sucré). Près de 400 médications (anti-inflammatoires, antidiabétiques oraux, inhibiteurs de l’enzyme de conversion…), des carences en zinc ou en vitamine B3, la cirrhose du foie ou la déshydratation perturbent le goût. La malnutrition aggrave ces déficiences, ralentissant ainsi le renouvellement cellulaire indispensable à la régénération des acteurs sensoriels. La perte d’appétit découle aussi d’une sénescence des glandes salivaire. Les aliments n’étant plus correctement imbibés, les molécules porteuses de saveurs appétissantes sont moins actives. De plus, la dégradation dentaire et la prédilection pour des aliments plus liquides diminuent les mouvements masticatoires ce qui va encore réduire cette sécrétion. La sécheresse buccale (xérostomie) est alors fréquente, exacerbée par de nombreux médicaments (diurétiques, benzodiazépines, antihistaminiques…), elle va favoriser les caries dentaires, les mycoses buccales et œsophagiennes, occasionnant des brûlures lors de l’ingestion et, in fine, gênant l’élocution et la déglutition. La muqueuse gastrique, en s’atrophiant, sécrète moins d’acide chlorhydrique, d’où une pullulation bactérienne consommatrice de nutriments (folates) et un retard à l’évacuation gastrique de 2 à 3 fois plus long, qui prolonge la phase d’anorexie post-prandiale. L’accélération plus importante chez la PA du transfert du chyme de la partie supérieure de l’estomac (le fundus) à la partie inférieure (l’antre) avec une distension précoce de cette dernière joue par ailleurs un rôle prépondérant dans le sentiment précoce de satiété. Un peptide, le CCK sérique (cholecystokime -pancreozymine), produit par le duodénum au cours du repas, stimule la sécrétion par le pancréas de la trypsine qui inhibe en retour la sécrétion de CCK. L’insuffisance pancréatique exocrine, liée à l’âge ou aggravée par une dénutrition, lève ce rétrocontrôle, d’où une production accrue de CCK à l’origine elle aussi d’une satiété précoce. La survenue plus fréquente chez la PA d’ulcères et de gastrites chroniques, en liaison avec une incidence plus élevée d’infection par Hélicobacter pylori, renforce encore le risque anorexique. Le vieillissement musculaire et la diminution du capital musculaire (sarcopénie) est un phénomène presque inéluctable qui commence à 40 ans pour l’homme contre 50 ans pour la femme. La perte -de 3 à 8 % tous les dix ans- s’accélère après 60 ans et réduit la musculature à 17% du poids du corps à 70 ans contre 30% à 30 ans. La composition en fibres du muscle se modifie : les fibres de type II, ou fibres blanches, à contraction rapide, mais peu résistantes à la fatigue, s’atrophient ; les fibres de type I ou fibres rouges, à contraction lente, générant peu de force, mais une forte endurance, sont moins affectées et leur densité serait même plus importante. Outre cette réduction de la force musculaire malgré une certaine préservation de l’endurance, le système nerveux contrôle moins bien ces contractions. Plusieurs facteurs génétiques, médicamenteux, nutritionnels ainsi que l’augmentation des cytokines (état inflammatoire provenant de l’accroissement de la masse grasse) conditionnent l’apparition de cette sarcopénie. Les hormones sexuelles joueraient aussi un rôle dans le contrôle de l’appétit au cours du vieillissement. La diminution des taux circulants de testostérone observée au moment de l’andropause induirait la perte d’appétit chez l’homme âgé et précipiterait le développement de la sarcopénie. À l’inverse, la réduction de sécrétion des œstrogènes à la ménopause protégerait les femmes de cette perte. Les répercussions de la sarcopénie sont considérables : risques infectieux par baisse des réserves protéiques nécessaires aux défenses immunitaires, chutes et fractures éventuelles compromettant l’autonomie de la PA… Un moindre volume musculaire expose aussi la PA aux troubles de la thermorégulation, la baisse de l’intensité du frissonnement qui en découle rendant la PA plus démunie face à l’exposition au froid. 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) - REFERENCE MOUSSAYER KHADIJA Doctinews N° 25 Août/Septembre 2010, ACTUALISATION JUIN 2024 - POUR EN SAVOIR PLUS : La plupart des personnes âgees souffrent de maladies chronique le plus souvent d'origine auto-immune Les maladies auto-immunes résultent d’un dysfonctionnement du système immunitaire, censé nous protéger des agressions extérieures, qui va le conduire à s’attaquer à notre propre organisme. Elles constituent un important problème de santé publique du fait de leur poids économique et humain : 3ème cause de morbidité dans le monde après les maladies cardiovasculaires et les cancers, elles touchent en effet près de 10 % de la population mondiale et occupent le deuxième ou le troisième poste du budget de la santé dans beaucoup de pays. Enfin, dernier point méconnu mais pas le moindre, ces maladies concernent les femmes dans plus de 75 % des cas : une femme sur six en est atteinte au cours de sa vie ! Passons donc en revue ce que sont ces pathologies et les actions de l’associations AMMAIS UN PROCESSUS D'AUTODESTRUCTION DE L'ORGANISME Notre système immunitaire est composé notamment de cellules spécialisées comme les lymphocytes et de substances (les anticorps) chargées normalement de nous défendre contre toute attaque extérieure provenant de différents virus, bactéries, champignons et autres produits délétères. Lors d’une maladie auto-immune (MAI) ou à manifestations auto-immunes, des éléments de ce système se trompent d’ennemi et s’en prennent à nos tissus et cellules. Certains anticorps devenus nos adversaires s’appellent alors « auto-anticorps ». Au total, il existe près d’une centaine de ces troubles.
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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Heinrich Cornelius Agrippa 234

Heinrich Cornelius Agrippa von Nettesheim (1486–1535) was a German polymath, physician, soldier, and occult philosopher whose writings laid the intellectual foundations for much of the Western esoteric tradition. He is best known for his magnum opus, *De Occulta Philosophia Libri Tres* (Three Books of Occult Philosophy), a comprehensive synthesis of magic, Kabbalah, Neoplatonism, Hermeticism, and Christian mysticism. In Agrippa, the currents of the Renaissance—scientific curiosity, classical revival, and spiritual yearning—converged in a deep and somewhat controversial body of work. Born in Cologne in 1486, Agrippa was educated in classical literature, theology, and law, but he also immersed himself in the esoteric arts—alchemy, astrology, angelology, and ceremonial magic. He traveled widely across Europe, engaging with scholars, nobility, and religious authorities. He often served as a physician and lecturer, while simultaneously pursuing his deeper passion for the hidden structure of reality that he believed could be revealed through magickal philosophy. Agrippa was a direct student and correspondent of Johannes Trithemius (1462-1516), the abbot of Sponheim and a key figure in early modern magical and cryptographic studies. Trithemius, known for his own influential work *Steganographia*, served as a mentor who inspired Agrippa’s lifelong pursuit of hidden knowledge and spiritual science. He also encouraged Agrippa to refine his ideas on occult philosophy into a systematic form, which would later become *De Occulta Philosophia*. In *De Occulta Philosophia*, Agrippa organizes magick into three interconnected worlds: 1) The Elemental world, governed by natural philosophy and the powers of the four elements (earth, water, air, fire). 2) The Celestial world, influenced by the movements of the stars and planets—i.e., astrology. 3) The Intellectual or Divine world, ruled by angelic hierarchies, divine archetypes, and the mysteries of the Kabbalah. For Agrippa, true magick was not superstition but a sacred science, a means by which the human soul could ascend through the created order toward union with the divine. He viewed the magician not as a manipulator of forces for selfish ends, but as a philosopher-priest who, through study, virtue, and divine illumination, could harmonize with the cosmos and act as a mediator between heaven and earth. Yet Agrippa’s life was marked by tension and contradiction. He often ran into problems with church authorities, accused of heresy or subversion. In his later years, he published *De Incertitudine et Vanitate Scientiarum* (On the Uncertainty and Vanity of the Sciences), a scathing critique of dogmatic knowledge, including his own magickal writings—though many scholars interpret this as rhetorical irony or spiritual disillusionment rather than renunciation. Agrippa died in 1535, likely in Grenoble. Though seen by some as a charlatan and heretic, his influence endures until today. His Occult Philosophy became a cornerstone of Renaissance magic, shaping later figures like John Dee, Giordano Bruno, and Eliphas Levi. Even modern Hermetic and ceremonial traditions—such as the Hermetic Order of the Golden Dawn—owe much to Agrippa’s system of correspondences and metaphysical cosmology. Nowadays, Agrippa is recognized not merely as a magician, but as a pioneer of symbolic thought, a bridge between medieval mysticism and modern esotericism. His work continues to guide and inspire those who seek the hidden harmonies of the universe—through reason, reverence, and the transformative power of the imagination.

Perfect Imperfection 351

She has beautiful imperfection The right kind of right The sad song played happily when the black dog critic cries here after her Fragility and lies from un-cropped truth- this is something entirely surreal Hold on to embrace her necessity, and life gives life to her again The failed faucets of memories are for the taking- hurry up, love and let’s start to make mementos See the seas to sight and songs played loudly, quiet between the space of us I am trust and bare bones, I see the perfect imperfection in passing lines formed on your face Imperfection by society's eyes and mouth, unmoved and unbreakable determination - you make the bitter taste sweet. You are perfect imperfection.

Divided by time and Diluted by the days 354

What you are is the resistance to yourself - exhausting life and preserving it at the same time- until you are not here. Rest from rest Work from work Is this not what life is - self-examination of the self, the echo you hear that comes to you, not from you. My thoughts are not mine then- they come to me from whom? I am this, the I behind I - or my mind behind my mind. Rest from rest Work from work I’m divided by time, diluted by the days ahead of me, I am what is left over 20 yrs, 30 yrs, and more. How much can I give each day? What will be left? How does this end? The perfect start to a bad ending? A bad start with a perfect end? Rest from rest Work from work Have you preserved and exhausted yourself and lived a full life in the best way you could? If not, try again!

Be Free From Yourself 355

What are we waiting for? You and I Living and dying in an eternal day Waiting for the light to fade away? I lie in the bed at night to read or see the stars, and I feel 1000 pounds on me- because life holds and presses hard, not because of difficulty. I can beat life, but it presses hard and holds me down because I am waiting; waiting for what? I have ideas. Our lives have been turned in on themselves, and now we wait for things to happen—most of the time. I don’t think we waited much in the past for things, and maybe we will wait more in the future. This cannot be good. Are some of us still in conflict with this- I don’t like waiting, and I am restless. It is time to make things happen and free myself of this feeling.

Morocco, 18th Global Power in the World Athletics Championships Thanks to a Rich History of Medals 681

The national sports memory proudly retains the very rich medal record of the country, accumulated since the advent of the World Athletics Championships in 1983. This idea was born from a visionary and innovative president of the IAAF, the Italian Primo Nebiolo. At that time, the athletics world gathered in Helsinki for an unprecedented experience. Athletics was just beginning to organize quality meetings and barely tolerating that athletes receive some monetary compensation for their performances. Until then, at the global level, athletes only competed at the Olympic Games and were not entitled to any payment or commercial contracts. While Morocco was not present at the first Olympic Games, it made its mark at this inaugural edition of the World Championships alongside two other African countries: Ethiopia, which won a silver medal, and Nigeria which, like Morocco, won a bronze. Since then, Morocco has ensured a certain continuity with very honorable results. Notably, a 5th place finish in 1999 in Seville, an edition marked by controversy: Nezha Bidouane was wrongly deprived of the gold medal in the 400m hurdles due to a judging error. Despite an appeal to the jury and clear evidence brought by the left photo-finish, the decision was not overturned. President Nebiolo had promised to repair this injustice at the first IAAF council meeting but unfortunately passed away in the meantime. He was replaced by Senegalese Lamine Diack, the jury president who refused to revise the result, likely to avoid contradicting competition officials. At this Seville edition, Morocco won five medals, including gold by Hicham El Guerrouj in the 1500m and Salah Hissou in the 5000m. Two other silver medals were won by Nezha Bidouane in the 400m hurdles and Zahra Ouaaziz in the 5000m, while Ali Ezzine took bronze in the 3000m steeplechase. These achievements, realized under intense heat and a special atmosphere, allowed Morocco to rise to fifth place in the world medals table. It is worth recalling that this success occurred at the very beginning of His Majesty King Mohammed VI's reign, who has surrounded athletes with his generous royal care. Despite a recent decrease in the number of medals, Morocco still occupies the 18th place in the global medals table at the World Athletics Championships today. It was Said Aouita who opened the way at the first edition in Helsinki in 1983 by winning bronze in the 1500 meters. With a little more experience, he could have won the race, which was dominated by the British Steve Cram in just 3 minutes 41.59 seconds, and American Steve Scott, who finished second. Morocco was truly new at this level of competition. Among individual athletes, legend Hicham El Guerrouj is today the most decorated Moroccan at the World Athletics Championships, with six medals: four golds in the 1500 meters, and two silvers in the 1500m and 5000m. Another legend, Nezha Bidouane, leads the women's medal tally with three world medals, including two gold and one silver. She remains, like Hicham El Guerrouj in the 1500m, the most decorated in the world in the 400m hurdles. An analysis of results shows that it is in the 1500m that Morocco has won the most medals, including the four golds of Hicham El Guerrouj and the silver of Adil Kaouch, former junior world champion in this distance. Adding to this are Said Aouita and Abdelati Iguider, who each hold a bronze medal over this distance. On the women's side, the most medals were won in the 400m hurdles, thanks to Nezha Bidouane. The historical record of Moroccan athletics at the World Championships is rich: twelve male and four female athletes have represented Morocco at this level in seven disciplines: 400m hurdles, 800m, 1500m, 5000m, 10,000m, 3000m steeplechase, and the marathon. Let us not forget also the long jump with Yahya Berrabah's 4th place at the 2011 World Championships in Daegu. For the 20th edition, starting on September 13 in Tokyo, Morocco is participating with about twenty athletes. Hopes rest especially on Soufiane El Bakkali, who could join Hicham El Guerrouj in the number of gold medals if victorious. Fatima Ezzahara Gardadi is also cited as a potential medalist, her 2023 feat in Budapest where she won bronze in the marathon remaining fresh in everyone's memory. Summary of Morocco's medal record at the World Athletics Championships throughout history: - 1st edition, Helsinki 1983: Said Aouita, bronze in 1500m; Morocco's ranking: 21st - 2nd edition, Rome 1987: Said Aouita, gold in 5000m; Morocco's ranking: 9th - 3rd edition, Tokyo 1991: Moulay Brahim Boutayeb, bronze in 5000m; Khalid Sekkah, bronze in 10,000m; Morocco's ranking: 28th - 4th edition, Stuttgart 1993: no medal - 5th edition, Gothenburg 1995: Hicham El Guerrouj, gold in 1500m; Khalid Sekkah, silver in 10,000m; Khalid Boulami, silver in 5000m; Zahra Ouaaziz, bronze in 5000m; Morocco's ranking: 25th - 6th edition, Athens 1997: Hicham El Guerrouj, gold in 1500m; Nezha Bidouane, gold in 400m hurdles; Khalid Boulami, silver in 5000m; Salah Hissou, bronze in 10,000m; Morocco's ranking: 6th - 7th edition, Seville 1999: Hicham El Guerrouj, gold in 1500m; Salah Hissou, gold in 5000m; Nezha Bidouane, silver in 400m hurdles; Zahra Ouaaziz, silver in 5000m; Ali Ezzine, bronze in 3000m steeplechase; Morocco's ranking: 5th - 8th edition, Edmonton 2001: Nezha Bidouane, gold in 400m hurdles; Hicham El Guerrouj, gold in 1500m; Ali Ezzine, silver in 3000m steeplechase; Morocco's ranking: 10th - 9th edition, Paris 2003: Jaouad Gharib, gold in marathon; Hicham El Guerrouj, gold in 1500m; Hicham El Guerrouj, silver in 5000m; Morocco's ranking: 9th - 10th edition, Helsinki 2005: Jaouad Gharib, gold in marathon; Hasna Benhassi, silver in 800m; Adil Kaouch, silver in 1500m; Morocco's ranking: 10th - 11th edition, Osaka 2007: Hasna Benhassi, silver in 800m; Morocco's ranking: 28th - 12th to 14th editions (Berlin 2009, Daegu 2011, Moscow 2013): no medals - 15th edition, Beijing 2015: Abdelati Iguider, bronze in 1500m; Morocco's ranking: 32nd - 16th edition, London 2017: Soufiane El Bakkali, silver in 3000m steeplechase; Morocco's ranking: 31st - 17th edition, Doha 2019: Soufiane El Bakkali, bronze in 3000m steeplechase; Morocco's ranking: 31st - 18th edition, Eugene 2022: Soufiane El Bakkali, gold in 3000m steeplechase; Morocco's ranking: 22nd - 19th edition, Budapest 2023: Soufiane El Bakkali, gold in 3000m steeplechase; Fatima Zahra Gardadi, bronze in marathon; Morocco's ranking: 15th.

Morocco and the Cannabis Renaissance: History, Regulation, and Current Economic Challenges... 1089

Morocco has entered a major phase in structuring its cannabis industry, with the authorization to market 67 derived products: 26 cosmetics and 41 dietary supplements, all compliant with standards and duly registered with the Moroccan Agency for Medicine and Health Products. This step is preliminary to their placement on the national market or export. The National Agency for the Regulation of Cannabis Activities, through its vigilance, reflects the country’s determination to maintain its credibility with investors and foreign partners in a rapidly expanding global market. While many citizens believe that kif was banned because it is harmful to health, a historical review clarifies what really happened and why this miraculous plant suddenly became a target in the war on drugs. Hemp has had multiple uses for millennia. As a strong textile fiber, it was used to make sails and ropes for ships. Without it, humans could not have navigated for long distances. Early printed papers and clothing in many regions were also hemp-based. Its cultivation required little labor and water, making it a formidable competitor to cotton. The prohibition of cannabis must be reconsidered in light of the Industrial Revolution and the rise of cotton from the 19th century onwards. Spinning and weaving machines designed for cotton gradually made it the dominant fiber, driving its massive growth. Moreover, the British and American colonial empires exploited vast plantations with servile labor, first through slavery, then poorly paid workers. These powerful interests put hemp at a disadvantage. The decisive turning point occurred in the 1930s in the United States, when the cotton, paper, and emerging chemical industries, notably with synthetic fibers, allied to eliminate hemp. Harry Anslinger, then head of the U.S. Federal Bureau of Narcotics, likely in collusion with large industrial interests, led a campaign deliberately conflating industrial hemp with recreational cannabis. In 1937, the Marihuana Tax Act banned hemp cultivation. Thanks to propaganda and economic interests, this policy spread worldwide. In 1961, the UN Single Convention on Narcotic Drugs classified cannabis among strictly controlled drugs, even for medical and industrial use, thus marginalizing hemp over the long term. Cotton then became the dominant fiber, favoring industrial networks. In Morocco, kif, a traditional form of cannabis often mixed with tobacco and smoked in a sebsi pipe, lies at the heart of a rich and complex history marked by social, political, and economic dynamics. For centuries, kif has been grown mainly in the north, around Chefchaouen, Ketama, and Issaguen. Far from being just an illegal plant, it was historically tolerated and seen as essential to local subsistence. Used for its social and medicinal virtues, kif was part of daily life almost everywhere. Since 1906, a company was created to ensure state control over kif. Under the Protectorate, it was officially named the Régie du Kif et des Tabacs. The reasons were mostly fiscal from 1917. Spanish authorities in the north applied more flexible rules, pragmatically dealing with local tribes. Upon independence, Morocco inherited a complex dilemma: kif was deeply rooted in society but faced growing international pressure. Under Mohammed V and then Hassan II, the country adopted gradual measures. The state monopoly was abolished in 1957–1958, and cultivation became illegal, even though tacit tolerance persisted in some historic Rif zones. The 1970s marked a crackdown under increasing pressure from the United States and Europe. The Moroccan 1974 narcotics law strictly banned cultivation, consumption, and sale of kif. Yet despite heightened repression, clandestine production exploded, driven by strong European demand. The Rif established itself as one of the world’s major cannabis resin basins. After decades of prohibition and socio-economic conflicts linked to kif, and under pressure from scientists and the public, in view of global developments, Morocco took a turning point in 2021 by enacting a law framing the legal use of cannabis for medical, pharmaceutical, and industrial purposes. Recreational consumption remains prohibited. The state is gradually integrating growers into a legal, controlled sector, reducing informality and improving local economic conditions. The history of kif in Morocco is a trajectory marked by millennia of tolerance, colonial regulations, prohibitions imposed under international pressure, before opening the way to a recent, intelligent, legal, and regulated reconversion. Today, hemp is regaining recognition almost everywhere. Less water-intensive, soil-friendly, producing seeds, oil, and natural insulating materials, it is becoming a pillar of the ecological transition. This plant, once banned to protect powerful economic interests, now seeks to reclaim its historic and natural place. This revival is particularly visible in Morocco. The area legally cultivated with hemp more than tripled in 2025 with 4,400 hectares sown, mainly with the local “baladiya” variety, a tangible sign of growth after decades of informality. It is an economic revitalization lever for Rif regions traditionally dependent on an underground economy. The 2021 legalization aims to channel a historic production into a regulated framework while creating a high-value-added industry. Beyond agriculture, a complete chain of processing, packaging, certification, and export is being set up, generating fiscal revenues and enhancing Morocco’s attractiveness to international investors. It is no longer just about cultivating cannabis, but about developing a structured industry that respects strict standards and can compete in a dynamic global market. This economic transformation is seen as a chance to reconcile a long-illegal sector with the mechanisms of a powerful economy. Challenges remain numerous, from strict regulation to combating illicit diversions, organizing cooperatives, and fiscal adaptation. But the course is clear: transform an ancient agricultural heritage into an engine of inclusive growth and sustainable economic integration.