Clinicopathological features of adult right-sided cardiac masses: Analysis of 19 cases.

Background: Right sided cardiac masses are rare. The purpose of this study is to review the clinical experience and pathological characteristics of right-sided cardiac masses and to provide a prognostic analysis in our hospital. Methods: We retrospectively reviewed 19 consecutive cases of right heart masses diagnosed in our institution from 2016 to February 2020. All available clinicopathological features, imaging characteristics and disease outcomes were summarized and presented. Results: The subjects included 9 men and 10 women with a mean age of 48.5 years. The most frequent complaint was dyspnea. The most common site was the right atrium (42.1%) followed by the tricuspid valve (36.8%). Clinical diagnosis revealed vegetations in 8 patients (42.1%), thrombi in 7 patients (36.8%), myxoma in 1 patient, hydatid cyst in 1 patient and metastatic (secondary) masse was seen in 2 cases. In the 19 patients, 3 patients underwent surgery, 15 patients were managed with medical treatment, therapeutic abstention was indicated in one patient. 14 patients were all alive at the end of the follow-up period. In contrast, 5 patients were dead (26.3%). Conclusion: In our series, the majority of right cardiac masses were benign, outnumbering the malignant ones, as described in the literature. The mortality rate was relatively high about 26.3%.

Infective endocarditis in hemodialysis patients: A 10-year observational single center study.

BACKGROUND: The incidence of infective endocarditis (IE) in chronic hemodialysis (CHD) patients remains high, despite the preventive measures implemented by nephrologists, especially the rigorous respect of hygiene, the use of antibiotic locks for catheters and the use of tunneled catheters instead of non-tunneled. OBJECTIVE: The objective of this study was to determine the clinical, biological, and echocardiographic characteristics, and the prognosis of IE in CHD. PATIENTS AND METHODS: It was a retrospective study, conducted from December 2010 to March 2020, at the Nephrology and Cardiology units of University Hospital in Oujda, Morocco. RESULTS: We compiled a series of 31 CHD patients having developed IE. Eleven cases (35.4%) were collected between 2010 and 2015, and 20 cases (64.6%) between 2016 and 2020. The mean age was 47 ± 19 years, 58% were male, and 25.8% of patients had diabetes. Vascular access for hemodialysis was by arteriovenous fistula, non-tunneled catheter, and tunneled catheter in 22.5%, 32.2%, and 45.2%, of the cases, respectively. About 25.8% of patients had benefited from more than two catheters (tunneled or non-tunneled) during the 3 months preceding the occurrence of IE. The mitral, tricuspid, and aortic valves were the site of IE in 41.9%, 41.9%, and 13% of the cases, respectively. Right heart IE and left heart IE were observed in 42% (13 cases) and 58% (18 cases) of cases, respectively. Blood cultures were negative in 58.1% of the cases at the time of diagnosis of IE. Staphylococcus aureus was identified in 69.2% of the cases. Mortality occurred in 54.8% of the cases. CONCLUSION: IE remains a severe condition in CHD patients with an increasing incidence. Rigorous prevention and screening strategies should be implemented at the hemodialysis centers.

Severe hypercalcemia requiring acute hemodialysis: A retrospective cohort study with increased incidence during the Covid-19 pandemic.

BACKGROUND: The Covid-19 pandemic has had dramatic consequences on the progression of numerous pathologies, especially neoplastic ones. The orientation of hospital activities toward the care of patients with SARS-Cov2 infection has caused significant delays in the diagnosis and therapy of many other pathologies. What about severe hypercalcemia? The aim of this work was to determine the clinical and biological presentation, etiologies, mortality, and the impact of the Covid-19 pandemic on severe hypercalcemia. MATERIAL AND METHODS: we conducted a retrospective study for 84 months (September 2014 to September 2021) at the Nephrology Unit in University Hospital Mohammed VI, Oujda, Morocco. Included were all adult patients diagnosed with severe hypercalcemia (defined as corrected total serum calcium of >3.5 mmol/l or > 14.0 mg/dl) and who had benefited from one or more hemodialysis sessions. RESULTS: 66 episodes of severe hypercalcemia occurred in 64 patients. The mean age was 57 ± 15 years and 57.6% were female. The mean corrected serum calcium at admission was 16.9 ± 2.1 mg/dl and 33.3% had more than 18.0 mg/dl. Malignancies represented 80.4% of all etiologies. Acute kidney injury was observed in 69.7%. The delta drop in serum calcium 48 h after initiation of medical treatment was 4.64 ± 1.63 mg /dl. Mortality was noted in 14% of all cases. Electrocardiographic abnormalities were observed in 58.3%, 87.5% and 85.7%, respectively, in group 1 (14.0-16.0 mg/dl), group 2 (16.1-18.0 mg/dl), and group 3 (> 18.0 mg/dl) (p = 0.04). The mean serum potassium value was 5.1 ± 1.3, 4.0 ± 1.0, and 3.7 ± 0.7 respectively, in group 1 (14.0-16.0 mg/dl), group 2 (16.1-18.0 mg/dl), and group 3 (> 18.0 mg/dl) (p < 0.001). Newly diagnosed neoplasia, severe hypercalcemia (> 16.0 mg/dl), and mortality have been observed in 15.4% vs. 23.7% (p = 0.31), 25% vs. 50% (p = 0.03), and 35.7% vs. 52.6% (p = 0.13) respectively, in patients before and during the Covid-19 pandemic. CONCLUSIONS: The Covid-19 pandemic caused an increase in both the incidence and severity of hypercalcemia and the hemodialysis practiced in this context remains efficient and safe.

Infective endocarditis in chronic hemodialysis: A transition from left heart to right heart.

Infective endocarditis (IE) of the left heart is the most frequent type of IE in chronic hemodialysis (CHD) (in 90% of cases) whereas involvement of the right heart is rare. The aim of this study was to determine the clinical, biological, and echocardiographic characteristics, as well as the prognosis of IE in CHD. This is a retrospective study conducted at the Center of Nephrology and Hemodialysis in Oujda, Morocco. Over a period of 56 months, we compiled data on a series of 11 CHD patients with IE. Their mean age was 40.5 ± 14 years, 72% were male and 27.3% had diabetes. All patients had native valve. All patients had bacteremia preceding the episode of IE. The tricuspid valve was the site of IE in 45% of the cases. Cardiac complications were observed in 72% of the patients and mortality was observed in 72% of cases. The period from IE diagnosis to death was 9 ± 6 days. In our study, the tricuspid valve was the most affected valve of IE in CHD.

[Evaluation and analysis of pain in chronic hemodialysis]. / Évaluation et analyse de la douleur en hémodialyse chronique.

AIM: Pain is an unpleasant experience that deeply affects patients' quality of life and emotional state. Pain's epidemiology and characteristics in chronic hemodialysis are not well known and insufficiently analysed. The aim of our study was to assess the prevalence, characteristics, impact and treatment of pain in our hemodialysis patients and determine its related associated factors. METHODS: We performed a cross-sectional study including 93 chronic hemodialysis patients. We collected demographic data as well as the aspects of the reported pain on the basis of the concise pain questionnaire, and finally inferred the risk factors related to pain occurrence. Chronic pain was defined as a pain that has existed for over three months. RESULTS: The prevalence of pain was 70.9% (n=66), mean age 55.3±13.3 years, sex ratio 30 males/36 females, mean duration of hemodialysis 82.4±57.29 (6-252) months. This pain was permanent, daily, intermittent and rare in respectively 9%, 28.7%, 48.4% and 13.6% of cases. It was mild, moderate, severe or unbearable in respectively 42.8%, 23.8%, 19% and 14.2% of cases. Pain was multifocal in 57.4% of cases. The most frequently reported pain sites were: shoulders (47.2%), head (41.2%), knee (34.5%) and back (20%). Thus, 53.8% of patients reported using analgesics, with a daily intake, frequent or rare in respectively 28%, 44% and 28% of cases. The comparison between the group of patients reporting pain to the one without pain complaints in univariate statistical analysis found that age, Charlson's score, interdialytic weight gain and the rate of two dialysis sessions per week were linked to pain occurrence. However, in multivariate analysis, only age remained as a pain-associated factor. CONCLUSION: Pain in chronic hemodialysis patients is a very common complaint. Therefore, it is necessary to assess it regularly, using a suitable questionnaire.

[Nephroprotection in young type 1 diabetic patients treated with converting enzyme inhibitor]. / Néphroprotection chez le jeune diabétique de type 1 traité par inhibiteur d'enzyme de conversion. Résultats préliminaires d'une étude prospective.

CONTEXT: Diabetic nephritis is a renal microangiopathy that represents a major cause of morbidity and mortality in diabetic patients. It is expressed either by microalbunuria, proteinuria or renal failure, depending on the stage of the diabetes. In this context, angiotensin converting enzyme inhibitors (ACEI) slow down the progression of renal damage. OBJECTIVE: To assess the nephroprotector effects of ACEI in young type 1 Moroccan diabetics with varying stages of renal damage. Methods Prospective study including 29 patients exhibiting a diabetic nephropathy and/or hypertension having been followed-up for 1 year and treated with ACEI. The following parameters were analysed on inclusion, at six months and after 1 year of treatment: systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), urinary excretion of albumin, 24-hour proteinuria, creatininemia, creatinine clearance, glycosylated haemoglobin, kalemia, total cholesterol and triglycerides. RESULTS: The mean age of our patients was of 23.6 +/- 5.5 years, the age at onset of diabetes was of 9.3 +/- 2.6 years. According to the renal damage, we determined 4 groups of patients: Group I: microalbuminuria (10 patients), Group II: proteinuria (7 patients), Group III: renal failure (6 patients), Group IV: isolated hypertension (6 patients). Study of the progression of the clinical and biological parameters, during treatment with converting enzyme inhibitors (combined with diuretics in Groups II and III) revealed: In Group I: a decrease in urinary excretion of albumin, which returned to normal in 3 cases, in Group II: a decrease in the proteinuria, which became a microalbuminuria in 4 cases, in Group III: a stabilisation of renal function concomitant to a reduction in proteinuria, in Group IV: a significant reduction in mean arterial pressure. CONCLUSION: One year of treatment with ACEI appears effective on reducing proteinuria levels and stabilising the renal function in young type 1 diabetic patients.