C-Reactive Protein, Ferritin, and Procalcitonin in 300 Moroccan Patients with COVID 19.

BACKGROUND: COVID-19 is a true global pandemic since March 2020, and it is responsible in the majority of patients mild symptoms; however, a small number of patients progress to the severe form with acute respiratory distress syndrome (ARDS) and some of them progress to the very severe form which can be fatal when it comes to multiorgan failure. Thus, it is important to identify as early as possible patients at high risk of progressing to severe forms requiring early and specialized management in order to reduce mortality. METHODS: Our five-month retrospective study (May 2020 - October 2020) included 300 SARS-CoV-2 patients confirmed by RT-PCR and hospitalized in the Infectious and Tropical Diseases Center (CMIT), and in the Intensive Care Unit of the Military Hospital of instructions Mohamed V of Rabat (Morocco). Our objective was to compare the levels of C-reactive protein (CRP), ferritin, and procalcitonin (PCT) according to the clinical state and prog-nosis of patients. RESULTS: In our series of results, very significantly elevated levels of C-reactive protein, ferritin, and procalcitonin were associated with severe and very severe forms of COVID-19 disease as well as a poor prognosis. CONCLUSIONS: In the absence of international recommendations, the validation of clinical-biological scores involving different biological parameters in COVID-19 patients would allow a standardization of practices, a correct prescription of biological analyses and a risk stratification allowing to palliate the lack of medical resources and thus to reduce mortality.

Interpretation Difficulties of Serum Immunofixation Test in Immunoglobulin D Multiple Myeloma with Hidden Lambda Light Chains.

BACKGROUND: We report a case of immunoglobulin (Ig) D myeloma with hidden lambda light chains in a patient whose immunofixation test was very difficult to interpret: the IgD reacts with the anti-δ heavy chain antiserum but does not react with anti-lambda antiserum. The band in the D heavy chain lane is unmatched in light chain lanes and the band in lambda light chain lane migrates higher. METHODS: To distinguish between heavy chain disease and immunoglobulin with "hidden" light chains, the sample was exposed to a very high concentration of anti-lambda and anti-kappa antisera for 48 hours. RESULTS: The serum immunofixation test of the sample treated with anti-lambda showed a decrease in the intensity of the band corresponding to D heavy chain lane as well as the modification of its mobility confirming the presence of IgD with the hidden lambda light chains. CONCLUSIONS: The IgD myeloma with hidden light chains remains a rare entity, hence the interest of sensitizing health professionals to be vigilant and ensure a good diagnosis. The proposed technique is useful, simple, reliable, and less laborious than those previous reported in the literature. Medical laboratories using Sebia-Hydrasys® system should be aware of the described phenomenon in order to avoid identifying an IgD myeloma as a delta heavy chain disease.

[Biological profile of type I allergies at Mohamed V Hospital (Rabat- Morocco)]. / Profil biologique des allergies de type I chez les consultants de l'hôpital Mohamed V de Rabat.

Allergic diseases are ranked fourth considering the world health organization classification of diseases. The consequences linked to these ailments are huge for public health economics and the diagnosis is awkward due to clinical polymorphism and multifactorial aetiologies. The allergologic diagnosis is the result of weighing in clinical and biological findings. The biological assessment is made of qualitative specific and multiple-allergen serum IgE test, which once positive drives to skin test and each allergen-specific IgE level determination to conclude. Our study aims at displaying biological analysis results of incoming patients with clinical allergy conditions. We carried out a nine months retrospective study, from June 2007 to March 2008, with 200 outwards patients involved. Blood samples were collected using dry tubes and as recommended we first did screening tests for respiratory (Pharmacia Phadiatop) and food (fx 5) allergens, then for positive samples we proceeded to serum specific IgE assay (UniCap, Phadia). We also realized the total IgE assay on 46 patients using Roche Elecsys 2010 technology. 49% of patients enrolled in the study were positive to aerollergens, d1 Dermatophagoides pteronyssinus being the most incriminated (96.4%), and 2.5% to food allergens. On 13% of patients, we noticed a double sensitization to d1 and g6 (pollen of grasses). Concerning the total IgE dosage, we found 50% of patients tested with normal values, 28% of whom having a positive allergologic screening test. Further studies matching clinical data, skin tests to serum IgE assay are necessary to draw the profile of respiratory and dermatological allergies for our patients.

[Kidney vasculitis connected to cryoglobulinemia IIA and hepatitis B]. / Vascularite rénale dans le cadre d'une cryoglobulinémie mixte associée au virus de l'hépatite B.

We report the case of a 70 years old patient hospitalized for renal insufficiency and deterioration of the general state. The electrophoresis of serum proteins on freezing of agarose reveals the presence of a discrete peak of monoclonal pace on the level of the gammaglobulines identified by serum immunofixation like IgM of the kappa type. The research of the cryoglobulinemia carried out in a laboratory of city was made positive and typified like a monoclonal cryoglobulinemia IgM kappa, thus directing the diagnosis towards a disease of Waldenström. However, the result of the biopsy medullary made exclude any lymphoprolifératif syndrome. The positivity of the serology of hepatitis B justified a second request for study of the cryoglobulinemia, carried out within our laboratory. The cryoglobuline was typified like mixed (IgM kappa monoclonal and IgG polyclonales). This result associated with the immunological assessment and the renal biopsy made retain for our patient the diagnosis of a kidney vasculitis connected to an infection chronicle by the virus of hepatitis B. This observation points out the interest of the preanalytic, analytic and post analytic phases in the study of the cryoglobulinemias. A good technical control is today the only guarantee of the quality of the result of this examination which has large importance in internal medicine in the etiologic assistance with the diagnosis of certain clinical demonstrations.

[The prevalence of adolescent asthma in Rabat. A survey conducted in secondary schools]. / Prévalence de l'asthme de l'adolescent à Rabat. Enquête dans les établissements de l'enseignement secondaire.

An enquiry was made to determine the prevalence of asthma in adolescents and was achieved using a questionnaire which was filled in by the pupils in secondary schools in Rabat. The sample was determined by a systematic poll of 1,616 pupils of whom 1,464 (90.6%) replied. 88 pupils (6.0%) replied in the affirmative to the question "Have you ever had whistling noises in the chest?", 78 (5.3%) to the question "Have you ever had a sensation of respiratory difficulty or suffocation with a whistling noise in the chest?", 48 (3.3%) to the question "Have you ever had asthma?" and 36 (2.5%) to all 3 questions and 114 (7.8%) to one or other of the questions. After a detailed questionnaire had been carried out on 110 of 114 pupils the diagnosis of asthma was confirmed in 50, which gives an estimation of the accumulative prevalence of 3.4% +/- 0.9%. This prevalence is higher amongst the oldest children in the family (26 out of 349, 7.4%) compared to the birth order of the other brothers and sisters (24 out of 1,112, 2.2%) (p less than 0.001). Pupils from higher social backgrounds (22 out of 256, 8.6% against 28 out of 1,208, 2.3% from more average or more poor social backgrounds, p less than 0.01). A past family history of asthma were more often noted in asthmatics (38 out of 50, 76%) than in non-asthmatics (406 out of 414, 28.7%) p less than 0.001). In the same way cough and phlegm and episodes of bronchitis occurring in autumn and winter and breathlessness on effort are more frequent in asthmatics; 20 out of 50 (40%) against 318 out of 1,414 (22.5%) for the cough (p less than 0.01), 12 out of 50 (24%) against 157 out of 1,414 (11.1%) for phlegm (p less than 0.01), 31 out of 50 (62%) against 337 out of 1,414 (23.8%) for episodes of bronchitis (p less than 0.001) and 15 out of 50 (30%) against 219 out of 1,414 (15.5%) for breathlessness on effort (p less than 0.001). Besides this we have noticed a slight predominance of asthma in boys compared to girls but the difference is not significant.