[Microscopic observation of bacteria on MGG stained blood smear in a patient with decompensated cardiac failure by infection]

The presence of inclusions miming cocci and bacilli on MGG stained blood smears is a routine event in laboratories. However, performing peripheral blood smear to detect microorganisms in context of sepsis is not recommended for diagnosis of bacteremia because of its low sensitivity compared to blood culture. Otherwise, the fortuitous detection of bacteria on MGG stained peripheral blood smear for leucocytes differentiating purpose represents an evidence of strong bacteremia frequently associated with poor prognosis. Before accepting a diagnosis of sepsis and bacterial involvement, we need to perform more investigations as well as blood cultures or free culture methods. In this way, we report a single case of a sever sepsis detected fortuitously on MGG stained blood smear for leucocytes differentiation by the presence of free and intra-leukocytes lengthened inclusions in a patient hospitalized in intensive care unit and dead for multi-visceral insufficiency despite the early wide spectrum antibiotic use then adapted antimicrobial therapy once microbiological results were provided

Determinants of consultation, diagnosis and treatment delays among new smear-positive pulmonary tuberculosis patients in Morocco: a cross-sectional study

We conducted a cross-sectional survey in 2012 in 12 selected provinces and prefectures in Morocco to determine consultation delay [patient delay], diagnosis delay and treatment delay [health system delays], and factors relating to these delays. The sample included 250 eligible and consenting newly diagnosed smear-positive pulmonary tuberculosis patients who were interviewed at the time of their registration within Diagnosis of Tuberculosis and Respiratory Diseases Reference Centers [CDTMR] or Integrated Health Centers [CSI] using a pretested and structured questionnaire. The median total delay was 46 days [inter-quartile interval [IQI] = 29-84 days]. Patient delay [median = 20; IQI = 8-47 days] was higher than health system delay [median-15; IIQ = 7-35 days]. Being illiterate, thinking symptoms will disappear by themselves; having financial constraints and feeling fear of diagnosis or social isolation were associated with patient delay. Consulting first in the private sector or having 3 or more consultations before diagnosis was associated with health system delay

Preparedness and health risks associated with Moulay Abdellah Amghar moussem, Morocco, 2009-2010

The objective of this study was to describe the risks and human health outcomes associated with attendance at the Moulay Abdellah Amghar moussem [a pre-planned mass gathering attracting more than 360 000 participants] for the purposes of public health prevention, planning, preparedness and response. We performed an environmental health risk assessment and retrospectively reviewed local health centre records before, during and after the event. In addition, standardized interviews with key stakeholders were performed to qualitatively evaluate local public health preparedness and response capacities. During the event, average daily health centre visits increased 5-fold. The sex ratio of health-care visits changed significantly from an average of 1.8:1 female:male visits per day to 1.2:1. The proportion of injuries varied from an average of 3.7% pre- and post-event to 14.8% [P < 0.01] during the event. A significant increase in digestive diseases was also observed during the event. Recommendations include increasing accessibility to free sanitation and hygiene facilities and improving health communications concerning hand washing and food and water safety

[Diabetic ketoacidosis and thyroid storm occurring while awaiting radical treatment, about 2 cases]

The association of uncontrolled type 1 diabetes and Grave's disease may induce metabolic decompensation leading to the simultaneous occurrence of diabetic ketoacidosis and thyroid storm. This double endocrine emergency, although rare, is known to be life-threatening. Diagnostic difficulties due to an atypical presentation of thyroid storm that can be masked by diabetic ketoacidosis result in delayed diagnosis and treatment and therefore in a fatal outcome. We report two cases in whom early recognition and intensive treatment have led to an improved outcome. Radical treatment of the Grave's disease immediately at the diagnosis of the associated type 1 diabetes may prevent this double complication

hyperosmolar decompensation of diabetes mellitus about 57 case

Between 1989 and 2000, 57 cases of hyperglycaemic hyperosmolarity were diagnosed in the department of Endocrinology-Diabetology of Farhat Hached Hospital in Sousse. The age of our patients was between 46 and 98 years and the sex-ratio was 0.9. Type 2 diabetes was found in 87.8% of cases, while patients under insulin therapy represented 12.2% of the cases and patients with unknown diabetes 35%. The precipitating cause was an acute infection in 59.6% of the cases, a iatrogenic cause in 42.1% [a use of diuretics in 33.3%], and a cerebrovascular accident in 20%. A handicap was present in 43.8% of the patients. Dehydration was present in all our cases, while a comatous state was found in 12.5% and hypotensive shock in 8.7%. On admission, the blood sugar was found to be between 21.4 to 64 mmol/l and the calculated osmolarity between 320 and 465 mosmol/kg. The mortality rate was 10.5% while the evolution was good in 80% of the cases

[Hypoglycemic comas from multiple sources in a type 1 diabetic]

Iterative hypoglycaemic comas in type 1 diabetic patients are a serious problem which may be caused by many factors like educational errors, unawareness of hypoglycaemia and also adrenal insufficiency and diabetic nephropathy while factitious hypoglycaemia is the major diagnostic pitfall. We report an unusual case of a 35-year-old man, who presents a type 1 diabetes for the past 23 years, and who had unexplained hypoglycaemic comas for the past four months even after decreasing his insulin doses. The investigation revealed factitious insulin injections but also the presence of adrenal insufficiency Graves' disease and diabetic nephropathy without renal failure. Psychiatric evaluation showed a depressive state induced by diabetic complications and hyperthyroidism. This case report emphasizes the fact that organic and factitious causes of hypoglycaemia may be present in the same patient that is referred for type 1 diabetic hypoglycaemia

[Long-term evolution of human macroprolactinomas treated with dopaminergic]

The aim of this study is to evaluate the long-term results of dopaminergic therapy in macroprolactinoma in the male. We report 5 cases of macroprolactinoma in men [age 27 to 40 years]. Four of the patients had expansive macroprolactinoma while the fifth one had an enclosed one. One patient was treated after failure of radio-surgical therapy, whereas the four other patients did not have prior surgery. Prolactin level was higher than 2500 mU/l in all cases with the presence of hypopituitarism and visual field amputation. All patients were initially treated with bromocriptin and had hormonal and pituitary CT or RMI follow up. Favourable evolution occurred in four patients with prolactin level normalisation within a few months to two years. There was a tumoral shrinkage in three cases within a period of 5 years. Bromocriptin resistance occurred in only one patient. Two years after ineffective pituitary external radiotherapy, quinagolide treatment lead to normalise prolactin levels and to reduce adenomous mass. These results emphasize the efficacy of dopaminergic therapy as first approach in macroprolactinoma in male. Nevertheless, it requires good compliance and the absence of side effects. Therefore, long acting dopaminergic or D2 receptor specific dopaminergic agents are excellent alternatives to surgery