Raman and ATR-FTIR analyses of medieval wall paintings from al-Qarawiyyin in Fez (Morocco).

A multi-analytical study has been undertaken to characterise wall paintings from the al-Qarawiyyin university in Fez, dating back to the 9th century and still in activity, with the aim of identifying the pigments used and going back to the painting techniques adopted by the Moroccan craftsmen of the time. The investigation crossed Raman and ATR-FTIR structural analyses along with XRF elemental ones, as well as colorimetric measurements. The colours and shades of six representative fragments collected during a recent excavation have been examined. Hence, red ochre (mainly hematite) was used to obtain brown-red colour, calcite for white, bistre for carbon-based black, while blue shades were achieved using azurite. Mixtures of pigments were created to widen the colour palette: cinnabar, minium and hematite were identified in orange hues while lapis lazuli and azurite were observed in grey-blue areas. The exploration of mortar layers revealed gypsum, gypsum/calcite and calcite type plasters. Furthermore, the observation of the morphological aspect of the interface between the plaster and the painting layer seems indicating that the lime-secco-painting skill had been the adopted painting technique.

Phytopythium vexans Associated with Apple and Pear Decline in the Saïss Plain of Morocco.

An extensive survey conducted in the Saïss plain of Morocco during the 2017-2018 growing season revealed that 35 out of 50 apple and pear orchards were infested with a pathogen that causes the decline disease. Morphological and phylogenetic tree analyses using the cox II gene allowed us to identify the pathogen as Phytopythium vexans. Interestingly, no Phytophthora and Pythium species were isolated. The occurrence and prevalence of the disease varied between locations; the most infested locations were Meknes (100%), Imouzzer (83%), and Sefrou (80%). To fulfill Koch's postulate, a greenhouse pathogenicity test was performed on the stem and collar of one-year-old healthy seedlings of apple rootstock M115. Symptoms similar to those observed in the field were reproduced in less than 4 months post-inoculation with root rot disease severity ranging from 70 to 100%. The survey results evidenced that apple rootstocks, soil type, and irrigation procedure may contribute significantly to the occurrence of the disease. The disease was most prevalent in drip water irrigation and sandy-clay soil on wild apple rootstock. Accordingly, a rational drip advanced watering system and good sanitation practices could eliminate water stagnation and help prevent the onset of this disease. It was concluded that Pp. vexans occurrence may be strongly influenced by irrigation mode and type of soil. Therefore, the obtained findings of this study could help to better understand the recurrence of this disease and to develop a reliable integrated strategy for its management.

Colocolic Intussusception in an Adult Patient Secondary to Caecal Adenocarcinoma.

Acute intestinal invagination is the pathology of infants and small children. Its occurrence in adults is rare, and it represents 1 to 5% of intestinal occlusions often leading to the discovery of an organic cause that may be tumor. We report the case of a 72-year-old patient admitted to the emergency room of Ibn Sina Rabat, Morocco, for intestinal occlusion. The abdominal CT scan showed a voluminous intestinal invagination on a very probable heterogeneous digestive mass. The treatment was an open right hemicolectomy. The histopathological examination of the surgical specimen concluded a colonic well-differentiated adenocarcinoma with a 30% mucinous component. By review of literature, we discuss diagnostic and therapeutic procedures in emergency.

[Self-induced dermatosis on the shoulder]. / Une dermatose auto provoquée de l'épaule.

Self-induced dermatoses are more and more frequent in adolescent substance abusers with adaptation problems. We here report a case of self-induced bullous lesions on the shoulder in an adolescent with major depression and suicidal ideations. The study involved a 22-year old man, who was a chronic smoker, an occasional user of cannabis and alchool with no particular past medical history, with divorced parents, in conflict with his father. He presented with bullous eruption on the left shoulder made of bubbles, post-bullous skin erosions and scabs on a healthy skin. The monomorphic appearance of lesions, their accessibility (on the left shoulder in a right-handed patient), patient's history and his psychiatric problems have immediately suggested the investigation of self-induced dermatosis or factitious disorder. The patient admitted that he had taken psychotropic drugs and that the self-induced lesions had been caused by cigarette burns. This first psichologic evaluation also showed that the patient had suicidal ideations and a self-and hetero-aggressive behavior. The patient was treated with emollients and healing creams and referred to the Department of Psychiatry for complementary therapies.

[Basal cell carcinoma: about a historical case]. / Carcinome basocellulaire: à propos d'un cas historique.

We here report the case of an 80 year old man, with clear phototype, villager, residing in one of the most isolated places in our kingdom, located at an altitude above 2400 metres. During humanitarian aid, he presented with ulcero-necrotic tumor infiltrating the nasal root and the right orbit with total destruction of the right eye. The patient reported that the lesion had progressed for two and a half years from a small bleeding papule on the nasal root with orbital spread. Clinical and histological appearance suggested the diagnosis of infiltrating basal cell carcinoma. Staging showed right naso-orbital bone invasion. Mutilating cancer surgery was indicated but the patient refused it. Basal cell carcinoma is reported to have a relatively good prognosis because of its slow and local evolution. However, some cancer types, such as infiltrative tumor occurring in some high-risk areas, including the naso-orbital region, can be rapidly devastating, mutilating and voluminous with aesthetic and functional impairements as well as difficult to manage.

[A rare and atypical cause of scrotal ulcerations]. / Une cause rare et atypique des ulcérations scrotales.

Salmonelloses are bacterial infections of the faecal peril; they are endemic in some regions of the world. They can colonize almost any organ hematogenously, hence, severe forms may be observed. We report a case of typhoid fever in a 16-year old young adolescent with no medical history, sexually transmitted diseases or sexual intercourses, presenting with necrotic scrotal ulcerations evolving over the past 3 weeks in a context of fever, diarrhoea, weight loss and alteration of the general state. Paraclinical assessment showed 7g/dl hypochromic microcyticanemia with target cells in blood smear and normal hemoglobin electrophoresis, biologic inflammatory syndrome, malabsorption syndrome, cytolysis and hepatic cholestasis 20 times above the normal, hepatosplenomegaly, normal viral serologic testing (HBV, HCV, HIV, EBV and CMV) and positive testing for salmonella. The patient underwent 3 weeks of therapy with fluoroquinolones with favorable evolution. Dermatologic manifestations are frequent and polymorphic in typhoid fever; however cutaneous and, in particular, scrotal ulcerations are rarely reported. Differential diagnosis may be based on sexually transmitted diseases, inflammatory bowel diseases or hematologic disorders. More often diarrhoea is reduced or absent and patient's outcome depends on antibiotic. Diagnostic confirmation in patients with an atypical clinical picture, as in the case of our patient, is based on serology. Treatment is based on proper and prolonged antibiotic therapy and on prophylaxis measures to neighbouring.

[Atypical and revelatory livedo reticularis!?] / Livédo atypique et révélateur!?

Atherosclerosis is a frequent and life-threatening complication in elderly patients with multimorbidity as well as with one or multiple cardiovascular risk factors. It can affect all the arterial trunks of the lower limbs and can cause obliterative arterial disease of the lower limbs. We here report the case of an elderly patient with ecchymotic livedo reticularis of the right thigh revealing ipsilateral obliterative arterial disease of the lower limb with septic loosening of total hip prosthesis. The study involved a 70-year old man with favorable atheromatous condition complicated 6 months before by ischemic heart disease revascularized with double prostheses (stent) and with right total hip prosthesis implanted 10 years before. He presented with large mesh and incomplete livedo reticularis associated with ecchymoses on the right thigh (A). Clinical examination showed reduced distal pulses in the right lower limb. Laboratory tests showed discrete inflammatory syndrome and normal haemostatic and immunological tests . Standard radiographic evaluation of the right hip showed a loosening of the distal end of the prosthesis (C). Echo-doppler of the lower limbs and angio-scanner showed occlusion of the right external iliac axis, right double primitive iliac stenosis and a lesion due to septic dislocation of the right femoral prosthesis with abscess collection measuring 48 mm/30 mm ( B). The patient was referred to the Division of Vascular Surgery for revascularization. Vascular imaging by echo-doppler and/or angio-scanner should be performed, in particular in elderly patients with livedo reticularis or venous collateral circulation and with cardiovascular risk factors.

A paraduodenal hernia revealed by bowel obstruction: case report and literature review.

Internal hernias are defined as the protrusion of abdominal viscera through an aperture in the intraperitoneal recesses, they are considered as a rare cause of intestinal obstruction. The paraduodenal hernias are the most common type of congenital hernia especially the left-sided ones. We report a case of a 46 year-old man presenting a left paraduodenal hernia with acute small bowel obstruction, which was firstly (preoperatively) assigned to a tumoral cause.

[Vitiligo revealing Vogt -Koyanagi-Harada disease]. / Vitiligo révélant une maladie de Vogt-Koyanagi-Harada.

Vitiligo is a chronic auto-immune skin disease, often associated or discovers other autoimmune pathologies. His association with Ophthalmological type pan uveitis and/or neurological type of meningitis and/or inner ear type of hearing loss determines the disease or Vogt -Koyanagi-Harada syndrome (VKH). We related the case of a young woman who consulted for recurrent uveitis for a year, and it was only with the onset of vitiligo lesions that VKH disease diagnosis was discussed and confirmed.

[Multiple and extensive skin necrosis revealing anti phospholipid antibody syndrome]. / Nécroses cutanées multiples et extensives révélant un syndrome des anticorps anti phospholipids.

Antiphospholipid antibody syndrome (APS) is an acquired thrombophilic state resulting from autoantibodies activity against phospholipides and/or their cofactors. It may be primary or associated with various diseases, including systemic lupus erythematosus (SLE), which represents a potential severity marker. We here report the case of a young girl with multiple cutaneous necrosis suffering from APS secondary to SLE. Skin lesions associated with APS are common, polymorphic, sometimes inaugural and may be the only clinical manifestation of the syndrome. However, skin necrosis are rare; their treatment is based on anticoagulation therapy and appropriate local care. Rigorous long term follow up associated with closer cooperation between the dermatologist and the internist is justified by unpredictable outcomes and poor prognosis.

Colorectal intussusception secondary to sigmoid carcinoma in an adult.

Although intussusception is relatively common in children, it is clinically rare in adults A 54-year-old woman who presented with cramping abdominal pain and rectal bleeding was found to have sigmoid rectal intussusception secondary to adenomatous polyps of the sigmoid colon. Following confirmation of intussusception by CT scan, surgical resection was performed after manual reduction.

[Duodenal leiomyosarcoma revealed by gastrointestinal hemorrhage]. / Léiomyosarcome duodénal: description d'un cas révélé par une hémorragie digestive.

INTRODUCTION: Leiomyosarcomas account for approximately 75% of all gastrointestinal sarcomas but only 8-10% of duodenal malignancies. Pain and bleeding are the principal symptoms. Prognosis of these tumors is difficult to assess. If excision is successful, however, prognosis is usually good. We report the case of a patient with leiomyosarcoma of the duodenum first identified because of gastrointestinal hemorrhage. CASE: We report the case of a 57-year-old women who underwent duodenopancreatectomy for duodenal leiomyosarcoma. Histological and immunohistochemical findings confirmed the diagnosis of low-grade leiomyosarcoma and ruled out a gastrointestinal stromal tumor. DISCUSSION: Duodenal leiomyosarcomas are very rare. Preoperative diagnosis is difficult. The combination of a mass and a hemorrhage must suggest the presence of leiomyosarcoma. Radiological and endoscopic findings may not be conclusive: only histologic examination provided the definitive diagnosis here. Many criteria have been used to assess prognosis; complete resection appears to be the principal prognostic factor and is associated with improved survival.