[Vitamin D profile in Moroccan lupus patients]

Our objective was to determine the vitamin D profile in Moroccan lupus patients. This is a retrospective study performed in the immunology laboratory of the Faculty of Medicine and Pharmacy of Casablanca, concerning 84 patients with Systemic Lupus Erythematosus confirmed by the revised criteria of American College of Rheumatology. 25-hydroxy-vitamin D [25 [OH] D] was assayed by an enzyme immunoassay [ELISA]. Status of vitamin D sufficiency is defined by a serum concentration of 25 [OH] D beyond 30ng/ml. After studying the clinical records of patients, an evaluation based on both of the vitamin D status and the associated systemic involvement was performed. The mean age of patients was 34.2 +/- 9.1 years, with extremes of 14 and 69, 85% of patients were female [sex ratio: 0.18]. The mean serum 25 [OH] D is 24ng/ml with a rate of 28 +/- 8.3 ng/ml in women, and 15 +/- 7.4 ng / ml in men. 67.7% of patients are vitamin D insufficient, and 15.1% are deficient. The lowest concentrations of 25 [OH] D were obtained in patients with glomerular disease with an average of 11ng / ml. Low levels of vitamin D should be common among Moroccan lupus patients. Studies in this direction are needed to confirm our results and to better understand the role of vitamin D in the prevention and the treatment of SLE and autoimmune diseases in general

[Impact of dialysis on the rate of C3 and C4 fragments and serum immunoglobulins]

Chronic Kidney disease [CKD] is characterized by impaired of innate and adaptive immunity. No studies have been conducted on disturbance of the immune system in Moroccans patients on hemodialysis. The aim of this study is to describe the cellular and humoral immune status in these patients. Fifty hemodialysis patients were recruited for this study. Lymphocyte subpopulations and assay of immunoglobulins and complement were determined for each patient. The analysis of the humoral response [dosage of IgGAM] showed increased levels of IgG, IgA and IgM in respectively 92, 28 and 2% of patients. Futher more a deficiency of IgM and IgA was found in 2 and 6% of patients respectively. Our results have shown high levels of C3 and C4 in 18 [36%] and 23 [46%] patients, respectively. Also a C3 deficiency in 3 patients [6%] and C4 in 5 patients [10%] was noted. Hemodialysis is accompanied by abnormalities of the innate and acquired immune system. Understanding the mechanisms underlying immune dysfunction on IRC, can improve lifestyle and reduce mortality in this group of patients. Several therapeutic strategies [targeted therapy] are being evaluated in order to avoid immune alterations in uremia

Isolated pancreatic tuberculosis: a medical disease causing surgical dilemmas: case report and review of literature

Tuberculosis [TB] affecting the pancreas is rare even in endemic countries for tuberculosis. The occurrence may pose a diagnostic problem in differentiating it from carcinoma of the pancreas. Clinical examination, laboratory data and imaging are all non-specific. Diagnosis is frequently misguided towards neoplasia requiring surgical intervention. We present one case of isolated pancreatic tuberculosis that was diagnosed by CT guided fine needle aspiration cytology [FNAC] illustrating the value of FNAC in such a situation, thus obviating the need for unnecessary surgery [laparotomy / laparoscopy] with its accompanying morbidity. The patient/s response to antituberculous drugs [quadruple therapy] was excellent. TB should be considered in the differential diagnosis of a pancreatic mass and most patients have an excellent response to standard antituberculous regimen. Thus, maintaining a high index of suspicion can assist in avoiding unnecessary laparotomies. We report this case as it is rare along with review of relevant literature

Cutaneous leishmaniasis caused by Leishmania major in Morocco: still a topical question

In the past decade in Morocco, there has been a reactivation of zoonotic cutaneous leishmaniasis [ZCL] foci with an unusual long outbreak episode. The aims of this review article were to update our knowledge of this disease in Morocco, to compare the situation with that prevailing in the other countries of the Maghreb region and to highlight factors that could be responsible for the current situation. The data indicate a global increase of ZCL incidence in the other Maghreb countries. Several factors could be influencing this increase but most of them will depend on human activities. On the other hand, ZCL is particularly sensitive to climate changes acting on the vector and the reservoir. An analysis of prevention strategies against the disease in Morocco and the other Maghreb countries highlights the need for integrated regional control measures in all the countries of the region

Pyogenic psoas abscess: discussion of its epidemiology, etiology, bacteriology, diagnosis, treatment and prognosis - case report

Psoas muscle abscess is a rare condition with vague clinical presentation, which presents a diagnostic challenge requiring a high index of suspicion. We report a case of primary pyogenic psoas abscess caused by Staphylococcus aureus. In this article, the epidemiology, etiology, bacteriological diagnosis and treatment options of this condition are discussed

Evaluation of ultrasonography in the diagnosis of suspected acute appendicitis

To assess the efficacy of ultrasound [US] as a diagnostic modality to establish the indications for surgery in patients suspected for acute appendicitis with equivocal clinical pictures. Design: Prospective randomized study. Setting: Departments of Surgery and Radiology, Al-Jahra Hospital, Al-Jahra, Kuwait. Subjects: A total of 148 patients suspected to have acute appendicitis admitted with equivocal clinical findings in the period from October 1997 to November 1999. Abdominal US using the graded compression technique. A positive US was defined as a tender non-compressible appendix with an outer wall to outer wall diameter of >6mm. The sonographic data w e re correlated with clinical, operative and pathological findings. Graded compression US results were analyzed and showed 97.4% specificity, 88.2% sensitivity, 95.3% accuracy, 90.9% positive predictive value, and 96.5% negative predictive value. The results are discussed and compared to previous reports. US was found to be a useful tool in the diagnosis of suspected cases of acute appendicitis with equivocal clinical findings. US helped to minimize negative laparotomies and avoid unnecessary appendectomies. US is, however, an operator-dependent investigative tool

Renal functions and serum fluoride concentrations in chronic renal failure patients after sevoflurane or isoflurane anaesthesia

Sevoflurane is metabolised to hexa-fluoro-isopropanol and inorganic fluoride ions by human liver. The peak plasma fluoride level is higher after sevoflurane than after isoflurane. Although this has no effect on renal functions in normal patients and volunteers, it might be risky on those with chronic renal insufficiency. In this study, 60 patients with stable chronic renal insufficiency who required surgical intervention were randomly allocated into one of two groups each of 30 patients; sevoflurane and isoflurane groups. We compared the renal functions [serum creatinine, urea, osmolality, sodium and urine osmolality] and the serum inorganic fluoride levels afler sevoflurane to those after isoflurane anaesthesia. Peak serum inorganic fluoride concentrations were significantly higher after sevoflurane than after isoflurane anesthesia [26 +/- 3 Vs 14 +/- 2 um/L]. Laboratory measures or renal functions remained stable throughout the postoperative period in both groups. No patient suffered a permanent renal damage of preexisting renal insufficiency and non required postoperative dialysis. There is no evidence that the increased fluoride levels after sevoflurane worsened the preexisting renal impairment. We concluded that the increase in serum inorganic fluoride after sevoflurane to levels as seen in this study are of little risk to patients with chronic renal insufficiency. Further studies to evaluate the effect of compound A on the renal functions on those chronic renal impairment patients are required

Haemodynamic, early recovery and renal function effects of desflurane anasesthesia in renal transplant

Twenty adult patients scheduled for liver related renal transplant with ASA physical status III were randomly allocated into two groups; desflurane and isoflurane, each of 10 patients. All patients were optimized pre-operatively by haemodialysis, homeostasis and control of all reversible pathological parameters as high blood pressure, blood sugar and serum electrolytes. They were given midazolam i.m. premedication and received either desflurane or isoflurane in N2O/O2-fentanyl during inaintenance. Atracurium in mcremental doses was given as a muscle relaxant. Full haemodynamic monitoring started in the pre-anaesthesia room and continue perioperatively every 3min NIBP, 5-chest leads ECG, CVP [every 5-10 min], HR., Sp O2, end-t-CO2 and neuromuscular transmission. Patients were ventilated to normocarbic with a closed circuit using soda lime. Anaesthesia and operative times were recorded as well as recovery parameters times. Urine was examined for organic and inorganic fluorides and blood inorganic fluorides was measured also [at 0. 4, 24, 72h] and I, as well as full renal functions and urine volume and osmolarity were measured [at 0, 4, 24 and 192 h]. There was a significant early recovery in desflurane than isoflurane group, Heamodynamically there were no significant differences between the two groups although the response to surgical stimulation was better controlled in desflurane than isoflurane groups. Renal function was markedly improved after transplantation without significant differences between groups. There was a slight insignificant increase of serum inorganic and urinary organic and inorganic fluorides in isoflurane than desflurane groups. The low solubility and very minimal metabolism of desflurane make it a safe and reliable inhalational anaesthetic agent compared to isoflurane specially in high risk patients as renal transplant patients