[Common variable immune deficiency lately revealed by gastrointestinal problems: about a case]. / Le déficit immunitaire commun variable à révélation tardive par des manifestations digestives: à propos d'un cas.

Common Variable Immune Deficiency (CVID) is rare. It is a constitutional deficit of humoral immunity characterized by recurrent bacterial infections and by increased frequency of tumors, autoimmune or granulomatous diseases. Gastrointestinal manifestations are very variable and sometimes reveal common variable immune deficiency. We report the case of a 31-year old patient with a history of childhood recurrent respiratory infections complicated by bronchiectasis and with a 3-year history of recurrent glairy diarrhea. Etiological balance was in favor of CVID with autoimmune manifestation (vitiligo). Patient's treatment was based on monthly immunoglobulin (Ig) infusions with favorable outcome at 2-year follow-up.

Viral hepatitis C and B among dialysis patients at the Rabat University Hospital: prevalence and risk factors.

The aim of this study is to investigate the prevalence of hepatitis C virus (HCV) and hepatitis B virus (HBV) in maintenance hemodialysis (HD) and continuous ambulatory peritoneal dialysis patients at the Rabat University Hospital and to identify the major risk factors for transmission. A retrospective study was performed in 67 chronic HD and 36 peritoneal dialysis patients. For the screening of viral infections, we tested for anti-HCV antibodies and HBs antigen (Hbs Ag). We compared infected and non-infected patients in order to determine the risk factors for contamination. In the HD unit, the prevalence of anti-HCV was 60% and the prevalence of HBs Ag was 6%. Duration of dialysis (P = 0.001) was the only risk factor in our HD patients. In peritoneal dialysis (PD), the prevalence of anti-HCV was 8%. Hbs Ag was detected in 2.6% of our PD patients. Viral hepatitis C is the main viral infection in our HD unit. The duration of dialysis is the main risk factor for infection in our study. The transmission is essentially nosocomial, requiring a strict adherence to infection control procedures.

Idiopathic membranous nephropathy preceding the onset of rheumatoid arthritis: a case report.

INTRODUCTION: Membranous nephropathy (MN) in the context of rheumatoid arthritis (RA), is often an iatrogenic complication due to the nephrotoxic effects of antirheumatic drugs. Rare cases of non-iatrogenic association between these two diseases were reported in the literature. CASE REPORT: A 30-year-old female patient presented in September 2005 with nephrotic syndrome. Renal biopsy showed features consistent with MN. Search for etiology was negative, particularly lupus serology which remained negative throughout the course of her illness. Accordingly, she was diagnosed as a case of idiopathic MN. Initially, she was treated with angiotensin converting enzyme inhibitors and angiotensin receptor blockers which maintained her protein excretion below nephrotic range for two years. Her nephrotic syndrome then relapsed and was treated with steroids and chlorambucil, according to the Ponticelli protocol. A few months later, she presented with early morning joint stiffness, polyarthritis involving the small joints of the hands, and strongly positive rheumatoid factor, fulfilling the diagnostic criteria of rheumatoid arthritis (RA). Her serum creatinine remained normal and a second renal biopsy revealed the same features of MN. Her RA was treated with pulsed methylprednisolone followed by oral steroids and methotrexate resulting in remission of the joints disease and the nephrotic syndrome. Remission was maintained for the last two years up to the time of this report. CONCLUSION: We hereby report a case of secondary membranous nephropathy that preceded the onset of rheumatoid arthritis by three years.

Survival of the first arteriovenous fistula in 96 patients on chronic hemodialysis.

BACKGROUND: Native arteriovenous fistula (AVF) represents the best vascular approach for chronic hemodialysis. The aim of this study was to determine the survival of the first AVF and to identify the factors responsible for poor AVF survival. MATERIALS AND METHODS: A retrospective study was conducted on 96 chronic hemodialysis patients benefiting from the creation and cannulation of their first AVF at our center, with a minimum follow-up period of 1 year. We collected demographic, clinical, and biological data, as well as analyzed the following AVF characteristics: anatomic site, cannulation time, survival, and complications. To identify the predictive factors of poor AVF survival, we defined and compared two groups of patients on the basis of whether they lost their first AVF during the evolution. RESULTS: Patients' mean age was 42.1 ± 13 years, with predominantly female patients. Mean AVF cannulation time was 17.5 ± 24 days. AVF loss was mainly related to thrombosis in 29% of the cases and stenosis in 9.4%. AVF survival was 87%, 77%, 71%, 67%, and 64% after 1, 3, 5, 8, and 10 years of hemodialysis, respectively. In our study, the main factors associated with AVF loss were lengthy jugular venous catheters placement (p = 0.004), short AVF cannulation time after its creation (p = 0.03), and hypotension episodes during dialysis (p = 0.03). CONCLUSION: Long-term survival and quality of life in hemodialysis depend on an appropriate dialysis carried out-thanks to a correct vascular approach! According to the previously published data, survival of the first AVF can vary between 10% and 36% at 10 years. In our study, survival of the first native AVF was satisfying because it reached 64% at 10 years. Early AVF creation and prevention and management of its complications remain the safest and most comfortable solution to ensure AVF survival and thus a satisfying survival and quality of life in chronic hemodialysis patients.

[Pregnancy and lupus nephritis: report of 20 cases]. / Néphropathie lupique et grossesse : à propos de 20 cas.

AIM: Pregnancies in women with lupus nephritis (LN) are a high-risk situation. The aim of this study is to evaluate the impact of pregnancy on LN on either maternal and fetal prognosis. PATIENTS AND METHODS: It is a retrospective study of 20 pregnancies in 12 women with lupus nephritis. RESULTS: There were 19 live births and five fetal losses. LN flares were observed in 50 % of the cases during pregnancy and 25 % after delivery. CONCLUSION: Pregnancies in women with LN require a multidisciplinary monitoring and intense maternal and fetal care.

[The evaluation and analysis of chronic pain in chronic hemodialysis patients]. / Evaluation et analyse de la douleur chez les hémodialysés chroniques.

INTRODUCTION: Pain is a sensorial experience and emotional discomfort associated with a potential tissue damage or described in terms evoking such injuries. Its management is a task for every physician. However, the epidemiology and characteristics of pain among chronic hemodialysis patients are incompletely defined. PURPOSE OF OUR STUDY: To evaluate the prevalence, characteristics, impact and treatment of chronic pain in chronic hemodialysis and its potential risk factors. METHODS: A cross-sectional study included 67 chronic hemodialysis patients in the Ibn Sina Hospital hemodialysis center in Rabat. We evaluated the sociodemographic characteristics of patients and pain features, as well as the response to analgesics. Pain is described as chronic when it persists for more than 3 months. The pain intensity was specified by a verbal scale. RESULTS: The mean age of our patients was 43.5+/-12.9 years with a feminine predominance (58.2%). The prevalence of pain was 50.7%. The pain was noticed for a mean period of 21 months (six to 60). This pain was continuous, frequent, intermittent and rare in respectively 20.6, 17.6, 47.1 and 14.7% of cases. The intensity of the pain was low in 3%, moderate in 41%, severe in 44% and very severe in 12% of cases. An osteoarticular origin was found in 76.5% of cases. A physical activity disorder was found in 67.6% of cases. Half of our patients were taking analgesics in 23.5% of cases, as daily use in 29.7% of cases frequently, and in 47.1% of cases rarely. These analgesics were level 1 in 47.1% and level 2 in 52.9% of cases. The therapeutic response is characterized by the disappearance of pain in 35.5% of cases. During dialysis sessions, pain intensity was the same in 79.4% of the patients. The risk factors associated with pain were an advanced age and a long length of time on dialysis. CONCLUSION: A systematic evaluation of pain is required to improve the quality of life of hemodialysis patients.

[Effects of anxiety and depression on haemodialysis adequacy]. / Troubles anxio-dépressifs et qualité de l'hémodialyse.

UNLABELLED: Depression and anxiety are the most commonly encountered psychological problems in patients with end-stage renal disease, especially those on renal replacement therapy. We sought to assess the prevalence of anxiety and depressive symptoms in patients undergoing haemodialysis treatment and to establish the relationship between these psychological problems and criteria of haemodialysis adequacy. METHODS: We implemented a transversal study on 93 adult haemodialysis patients recruited from in Ibn-Sina Haemodialysis department in Rabat in April 2003. They underwent three tests performed by a psychiatrist. The first one was the brief psychiatric rating scale (BPRS) and then Hamilton anxiety and depression rating scales. We also studied anthropometric features, comorbidity, dialysis session's characteristics, and the following haemodialysis adequacy parameters: extracellular volume, nitrogenous retention, nutritional status, phosphocalcic balance, serum potassium, acid-basic equilibrium, anaemia, and inflammatory markers. RESULTS: The mean (+/-SD) age of our population was 42+/-15.5. The sex-ratio was 1.11 (49 W/44 M). Only one patient had a history of psychological care by a psychiatrist. The prevalence of depression and anxiety among the patients surveyed was 67 and 69.3% respectively. Seven patients had a severe depression. We did not found any other psychological condition by BPRS. Depression has been shown to be associated to several haemodialysis adequacy markers like high blood pressure, interdialytic weight intake, nutritional parameters (serum albumin concentration...), and serum creatinin concentration. Depression was more frequent in women, diabetics, and patients with C hepatitis. CONCLUSION: This study will be continued by a prospective screening of patients under appropriate therapy.