Think Forward.

GERIATRIE : LA NUTRITION FACE AU VIEILLISSEMENT PHYSIOLOGIQUE DES PERSONNES ÂGÉES - PARTIE 1 3265

Dr Moussayer khadija, 2 y.
- Science - Society - Health -
3.5 min read.
«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

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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Agentic AI Beyond Benchmarks: Meta-Agents & the Future of AI Evaluation with Khalil Mrini 315

Tariq Daouda, 1 d.
I recently sat down with Khalil Mrini to talk about his work and international experiences. He has spent time in Marrakech, Switzerland, India, and the United States, each place influencing his perspective in different ways. We also mentioned his visit at the UM6P, his experience of the university, students and innkvative AI curriculum. Khalil presented his new paper on agentic AI. The paper focuses on the use of autonomous agents to evaluate and benchmark other agents: essentially, systems that can test one another’s capabilities. He described how this approach could provide a more dynamic and optimal method for measuring progress in AI research. We ended the conversation by discussing AI ethics. Our exchange raised open questions about responsibility, transparency, and how the field can ensure that increasingly autonomous systems align with human values.
youtu.be/zE7PKRjrid4

A Historical Triptych: How Morocco, Spain, and Portugal are Forging the Success of the 2030 World Cup 422

Imad Khater, 2 d.
The assignment of the 2030 FIFA World Cup hosting rights to the unprecedented trio of Morocco, Portugal, and Spain marks the opening of a new chapter in the history of international and sporting relations. The joint organization of this event confirms an unparalleled dynamic, engaging the three nations in a triangular cooperation whose efficiency will be the decisive marker of this global event's success. This trilateral partnership transcends mere logistical collaboration to become a true lever for strategic development. The question is no longer whether bilateral relations are ready, but how their integration into a strengthened trilateral framework will guarantee the success of a mega-event poised to connect, for the first time, two continents through the medium of sport. Historical ties and geographical proximity provide a fertile ground for a remarkable intensification of relations between these three partners. The announcement of their tripartite bid has, in fact, elevated the need for harmonized coordination in the logistical, economic, and security domains to the level of a strategic imperative. I. The Political and Economic Foundations of Enhanced Cooperation The alignment around the 2030 project is not fortuitous; it is rooted in deep political and economic considerations that mutualize the interests of the three countries. •⁠ ⁠The Imperative of Convergence suffers no ambivalence: Spain and Portugal, while operating within the structural framework of the European Union, recognize Morocco as an essential strategic partner, a genuine gateway and pivot to the African continent. This dynamic is not unilateral; the Kingdom is consolidating its Euro-African anchor with heightened clarity through this same alliance. The World Cup deadline, far from being a simple calendar constraint, acts as a powerful lever, forcing the acceleration—often judged too slow—of regulatory, customs, and security convergence processes among the three capitals. Crucially, the political will displayed at the highest level—symbolized by the direct monitoring of Moroccan commitments by His Majesty King Mohammed VI—stands as a decisive catalyst, ensuring the establishment of a unified and enduring policy line, even in the face of contingencies and fluctuations in political majorities within the allied states. •⁠ ⁠Mutualization of Investments and Benefits: On the economic front, the World Cup represents an unprecedented opportunity to boost trade and investment. The trilateral agreements directly influence the planning of major works: the goal is no longer to build isolated infrastructures, but integrated networks (ports, air links, potential high-speed rail connections) designed for interoperability. The harmonization of tourism offerings and incentivizing fiscal regimes for sponsors and investors is crucial to maximize shared benefits. The success of coordination in the logistical, economic, and security domains will not be merely a performance indicator; it will be the symbol of a collective capacity to manage a complex event on a transcontinental scale. II. Managing Complexities: The Challenges of Co-Development An event of this magnitude, operated by three sovereign states, naturally generates frictions and coordination challenges that require first-rate diplomatic and technical management. •⁠ ⁠The Challenge of Global Security and Integrated Transport: The primary obstacle is the creation of a unified security space for the millions of supporters on the move. This demands real-time information sharing, coordination of law enforcement agencies, and the harmonization of emergency protocols. Concurrently, the transport system must be conceived as a single network. The transit of teams and supporters between Europe and Africa must be fluid, reliable, and ecological, necessitating targeted investments in airport capacity and maritime services. •⁠ ⁠The Cultural and Civilizational Vector: Beyond sport, the World Cup is a diplomatic platform. The secondary, but fundamental, challenge is to move beyond simple technical organization to present an ideal model of intercultural coexistence. Morocco, Spain, and Portugal must invest in promoting their cross-cultural heritages, consolidating the values of peace and mutual respect. This involves qualifying national institutions not only in logistics but also in public management and global media interaction, to avoid the pitfalls of fragmented or sensationalist coverage. III. The Structuring Influence of Bilateral Agreements on Logistics The influence of existing agreements between the three countries is vital for infrastructure development. The current stage is characterized by high anticipation from the private sectors and sports observers, who are watching for the concrete acceleration of construction projects. The overall efficiency of the operation—whether considering the pre-event phase, execution during the tournament, or the post-realization legacy—rests entirely on the solidity of the triangular commitment. The transformation of infrastructures, from stadiums to training centers and reception areas, must be carried out in a spirit of normative alignment. In conclusion, the 2030 World Cup is not merely the sum of three national organizations; it is a project of strategic co-development. The strong historical relations uniting the Kingdom of Morocco, Portugal, and Spain, amplified by a constant and high-level political will, constitute the decisive element for transforming this bid into a resounding success, offering the world a precedent of successful integration between two shores.

Law 30-09: A “Tree with Bitter Fruits” Hindering the Development of Moroccan Sports 424

Imad Khater, 2 d.
- Politics - Society - Sports -
2.5 min read.
While Morocco’s recent performances on the international stage—particularly in football—demonstrate its growing dynamism, the legal framework governing the sports sector seems unable to keep pace with this evolution. Conceived in the wake of the 2008 Royal Letter and enacted in 2010, Law No. 30-09, which was meant to modernize the national sports system, now reveals—fifteen years after its delayed implementation—serious limitations. Marked by internal inconsistencies, deficient enforcement, and pervasive state interference, the law ultimately undermines its original purpose: to professionalize Moroccan sport and align it with international standards. I. Excessive Requirements and Forgotten Sanctions Born from a clear political will to reform Moroccan sport and provide it with a modern legal framework, Law 30-09 has quickly become a rigid and impractical instrument. One of its most emblematic—and controversial—provisions is the obligation imposed on certain sports associations to establish sports corporations (Sociétés Anonymes). While the intent was to ensure sound governance, fiscal transparency, and executive accountability, practice has revealed the limits of this approach. •⁠ ⁠A disproportionate constraint. Most associations lack the financial and organizational capacity to comply with such structural obligations. •⁠ ⁠A flawed and inapplicable framework. The law establishes three non-cumulative conditions triggering the obligation to form a sports company. Only the first has been clarified by regulation, while the other two—relating to turnover and payroll—were never defined by governmental decree. As a result, the rule remains largely inoperative, especially since the penalties for non-compliance are systematically ignored. •⁠ ⁠An unfinished reform. Even among the few clubs that have complied, the parent association still holds the majority of the share capital. This structural lock prevents the opening of capital to private investors, thus maintaining dependency on the old associative model rather than promoting professionalization. II. The Persistent Shadow of the State: An Interference Contrary to Autonomy Principles By its very nature, sport is a sphere of autonomy, an ethos enshrined in the Moroccan Constitution and in the regulations of international organizations such as FIFA. Yet Law 30-09 establishes the supervising ministry as the true guardian of the sector, concentrating significant and often excessive powers: •⁠ ⁠An extensive right of scrutiny. The ministry approves statutes, grants accreditation, and confers authorization to national federations. •⁠ ⁠A pronounced power of interference. The administration may impose standard contracts and, more seriously, revoke authorization or dissolve a federation in the event of a “serious violation.” Such prerogatives contradict the spirit of the Constitution, which reserves this power to the judiciary. •⁠ ⁠Institutional omnipresence. A state representative must sit within the governing bodies of both the national federations and the Moroccan National Olympic Committee (CNOM), reinforcing state oversight at the expense of autonomy. This predominant executive control contradicts the principles of independence that underpin both national constitutional law and the global sports governance model. III. The Ambiguous Status of Athletes: The Law’s Major Omission Beyond institutional deficiencies, Law 30-09 exposes a serious legal vacuum regarding the status of athletes. The professional athlete’s contract is treated as an ordinary employment contract—an assimilation that raises significant difficulties. •⁠ ⁠The legislator had to create several exceptions to the Labour Code (five-year fixed-term contracts, exclusivity clauses, conditions for unilateral termination), resulting in an incoherent hybrid regime. •⁠ ⁠Although classified as “employees,” professional athletes do not enjoy the social protection and retirement benefits normally afforded to workers. •⁠ ⁠As for amateur athletes, their status remains completely unaddressed by the law. The provisions aimed at supporting athlete training and post-career reconversion are equally deficient. They are neither mandatory nor widely implemented, few training centers exist, and many athletes lack the educational background needed to benefit from such programs. IV. The Need for a Moroccan Sports Code Faced with these structural weaknesses, a piecemeal revision of the law is no longer adequate. The codification of sports law—through the adoption of a comprehensive Moroccan Sports Code—is now an imperative step toward supporting the country’s international ambition. Drawing inspiration from the French model, such a reform would serve several key purposes: 1.⁠ ⁠Clarifying and consolidating the dispersed legal texts, regulations, and case law to facilitate specialization among legal practitioners. 2.⁠ ⁠Correcting inconsistencies by redefining the jurisdictional competences of the State and creating a sui generis legal status for professional and amateur athletes. 3.⁠ ⁠Modernizing the legal framework by integrating fiscal and social regimes specific to sports entities and individuals. Despite its initial promise of modernization, Law 30-09 has become a “tree with bitter fruits.” Instead of fostering professionalism, it has constrained the sector and amplified its institutional fragility. Only a complete codification—reflecting Morocco’s socio-economic realities and the principles of good governance—can ensure a coherent, autonomous, and sustainable framework for the country’s sports development.