Cardiac Pre-tamponade Secondary to Generalized Myxedema Due to Neglected Hashimoto's Thyroiditis in a Child With Down Syndrome.

Down syndrome (DS) is the most common chromosomal disorder in live-born infants, often associated with intellectual disability and various medical conditions, including thyroid dysfunction. Hashimoto's thyroiditis (HT), an autoimmune subtype, is a leading cause of acquired hypothyroidism in DS children. Severe hypothyroidism can precipitate myxedema, a critical condition linked to complications like pericardial effusion and cardiac tamponade. This case study presents a nine-year-old male with DS who was admitted for acute respiratory distress exhibiting classic signs of myxedema. Initial investigations revealed severe hypothyroidism and significant pericardial effusion. Surgical pericardiotomy drained 800 mL of fluid, confirming myxedema secondary to HT. Levothyroxine therapy led to progressive improvement, resolving myxedematous infiltrate and associated symptoms within a month. Follow-up at 12 months demonstrated sustained improvement with normalized thyroid function and no clinical disease activity. This case highlights an atypical presentation of HT in a DS child with cardiac pre-tamponade.

Hypoparathyroidism Revealed by Unsuccessful Anti-epileptic Therapy.

Pediatric hypoparathyroidism is an uncommon endocrine disease that can be either isolated or syndromic. It occurs when the secretion of parathormone is insufficient to maintain normal levels of ionized calcium. Patients with hypoparathyroidism can exhibit cerebral calcifications and metabolic disorders, and the severity of such features is inversely correlated with hypocalcemia. We report a case of a 13-year-old patient who was initially diagnosed with epilepsy by another medical team two years before her admission to our hospital and who was subjected to oral valproate therapy. The anti-epileptic therapy proved to be unsuccessful even with increasing doses. The diagnosis was corrected when we performed adequate biological investigations. This case is underlying the importance of the electrolytes profile, especially the serum phosphocalcic test, in the management of patients with new onset or recurrent epileptic seizures.

Self-care intervention using mobile apps for sexual and reproductive health in the WHO Eastern Mediterranean Region.

Sexual and reproductive health (SRH) concerns physical, mental, and social well-being as related to sexual and reproductive systems. Self-care, which is the ability to promote health without the support of a health-care provider, can advance SRH, especially for fragile populations. Mobile health (mHealth) solutions can be used to raise awareness about SRH. We performed a structured literature review and analysis of mHealth-based approaches for delivering self-SRH services and interventions in the WHO Eastern Mediterranean Region (EMR). A fuzzy-based framework for assessing those mHealth apps was proposed. We identified 6 out of 737 papers, and 23 (5.7%) out of 400 mHealth apps retrieved from app-stores, describing mHealth use for self SRH with only 10 apps developed in EMR countries, namely Morocco, Pakistan, Egypt, Iran, and Jordan. Our fuzzy-based framework proposes guidelines regarding the implementation of self-care interventions to help project leaders promote their adoption in the SRH systems.

A Case of Cytomegalovirus Infection With Severe Thrombocytopenia in an Infant Who Was Successfully Managed With Antiviral Therapy.

Cytomegalovirus (CMV) is a member of the Herpesviridae family of DNA viruses. It is one of the major infectious causes that induce thrombocytopenia. We herein report a case of CMV infection in an infant complicated with severe thrombocytopenia that was successfully managed by antiviral treatment. A three-month-old girl presented with generalized petechial lesions in the limbs, trunk, and eyelids, discovered by chance during a vaccination consultation in an apyretic context. Blood examinations demonstrated thrombocytopenia at 26,000/mm3. She was diagnosed with immune thrombocytopenic purpura. Intravenous immunoglobulin was administered thrice and corticosteroid therapy at a dose of 2 mg/kg/day was started. The evolution during her hospitalization was marked by the increase to 373,000/mm3. A week later, the platelet had decreased again to 8000/mm3. Positive serology and high CMV DNA detected in serum by real-time quantitative polymerase chain reaction confirmed the diagnosis of CMV infection. In consideration of the severe thrombocytopenia, antiviral therapy with ganciclovir 5 mg/kg/12 hours was initiated. The platelet counts increased with decreasing CMV loads. She was discharged home after clinical stabilization with a close follow-up over one year.

Report of a New Case of Pentasomy X Revealed by Status Epilepticus.

This report describes an exceptional case of X (49, XXXXX) pentasomy in a girl aged three years and five months. She was admitted for recurrent seizures revealing epilepsy. She has growth failure and psychomotor retardation with a deformed face. The malformative assessment did not show any malformation apart from cerebral leukodystrophy. Pentasomy X is a very rare abnormality of the sex chromosomes. It only affects females, in whom three additional X chromosomes are added to the two X normally present. The pathogenesis of pentasomy X is not exactly clear, but it is probably caused by successive maternal nondisjunctions. Epilepsy and cerebral leukodystrophy are a new mode of revelation of this syndrome, never described in the literature.

New-Onset Diabetes with Ketoacidosis Precipitated by COVID-19 in Children: A Report of Two Cases.

BACKGROUND AND AIMS: There is growing evidence that the 2019 coronavirus disease (COVID-19) is emerging as a potential trigger virus for the development of diabetes mellitus in children. This can occur even in patients without factors predisposing to impaired glucose metabolism. Here, we report two rare cases of diabetic ketoacidosis revealing new-onset diabetes and precipitated by COVID-19. These cases are reported in view of their rarity and originality. The relationship between type 1 diabetes mellitus and COVID-19 is discussed. RESULTS: Two children developed symptoms suggestive of diabetic ketoacidosis preceded by polyuria, polydipsia, and asbestos. There is a documented COVID-19 infection in the parents of the 2 children. An asymptomatic infection was detected in the 2 patients on the basis of a reverse transcription polymerase chain reaction (RT-PCR) test. Thoracic imaging and inflammatory workup were negative in both cases. Both patients responded well to treatment, including rehydration regimens and intravenous insulin. On the 2nd day of their hospitalization, they were transferred to several injections of subcutaneous insulin with therapeutic and nutritional education from the parents. After about 4 weeks, their insulin requirements probably decreased due to the diabetes honeymoon. CONCLUSION: COVID-19 can induce acute onset diabetes and diabetic ketoacidosis in children. More research data are needed to improve our knowledge of this constellation and to guide the most appropriate therapies.

Acute pulmonary embolism mimicking COVID-19 pneumonia.

The case of 21-year-old man with an asthma history from childhood presenting severe respiratory distress associated with a right lower thoracic pain has been studied. The non-contrast Computed Tomography (CT)-chest scan showed a basal ground-glass opacity (GGO) of the right lung leading to suspicion of COVID-19 pneumonia. However, the molecular Reverse transcription polymerase chain reaction test and blood serology were negative while laboratory analyses revealed high levels of D-dimers (D-D). In addition, 2 repeated COVID-19 tests were negative. A thoracic CT angiography was disclosed due to the persistence of pain at the lower right thoracic side and hemoptysis that shows a bilateral distal pulmonary embolism with a right-sided basal subsegmental ischemia. We discuss a fortuitous discovery of pulmonary embolism associated with peripheral basal ground-glass opacities similar to radiological manifestations of SARS-CoV-2 pneumonia.

Obesity and Disease Severity Among Patients With COVID-19.

Background Obesity can be associated with one or more co-morbidities that worsen the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Studies demonstrated that severe forms of coronavirus disease (COVID-19) have occurred in elderly patients and patients with co-morbidities such as diabetes, hypertension, and cardiovascular diseases. Objective This study investigated the impact of obesity on COVID-19 severity, irrespective of other individual factors. Methods This retrospective observational study included all adult patients with confirmed COVID-19 infection, who were admitted to Sheikh Khalifa Ibn Zaid International University Hospital between March 20 and May 10, 2020. First, we compared patients with and those without obesity in terms of demographic characteristics, co-morbidities, clinical symptoms, and outcomes. Further, using logistic regression models, we analyzed the association between obesity and intensive care unit (ICU) admission. Also, we examined whether the association between obesity and ICU admission was also consistent among overweight patients. Results The study population included 107 patients with confirmed COVID-19 infection. Obese patients have been admitted in ICU more than patients without obesity (P-value = 0.035). While adjusting for other risk factors for ICU admission, we found that obesity was an independent risk factor for ICU admission (OR = 5.04, 95% CI (1.14-22.37)). When we examined the association of both obesity and overweight with ICU admission, we found that only obesity was significantly associated with ICU admission (OR = 9.11, 95% CI (1.49-55.84)). Conclusion Our study found that obesity was strongly associated with severity of COVID-19. The risk of ICU admission is greater in the presence of obesity. Physicians should be awarded to the need of specific and early management of obese patients with COVID-19 disease.

Severe SARS-CoV-2 Infection: A Multisystem Inflammatory Syndrome in Moroccan Children.

Until October 2020, children seem to have a mild form of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Morocco. Since April 2020, a new entity of multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection was reported in England, Italy, France, and the United States. This syndrome has similarities with the most frequent vasculitis in children, Kawasaki disease. Here, we describe the features and outcome of the first five cases of Kawasaki-like multisystem inflammatory syndrome in Moroccan children triggered by the SARS-CoV-2. The median age of the children was 7.8 years; three of them were boys. Criteria for Kawasaki disease were met in all of them with a complete presentation. Three patients required admission to a critical care unit with multi-organ failure in one of them, but no mortality occurred. They all received intravenous immunoglobulin (IVIG), a high dose of aspirin, methylprednisolone, and supportive therapy. Coronavirus 2019 disease (COVID-19) infection in children may be life-threatening; rigorous monitoring for several weeks is required in any positive child or living in a family cluster.

Acute Hepatitis and Pancytopenia in a Child With Chronic Abuse of Senna.

Long-term use of Senna and its anthraquinone glycosides has been associated with the development of hepatotoxicity in both children and adults. Our case study aims to present, for the first time, acute hepatitis associated with pancytopenia in relation probably to liver and bone marrow toxicity in a three-year-old child suffering from chronic abuse of Senna. We report the case of a three-year-old girl with a history of chronic constipation regularly treated with drinkable preparations made from the Senna plant and hospitalized eight months ago with an almost similar and reversible clinical presentation, probably of toxic origin. She was admitted to a pediatric intensive care unit with severe acute hepatitis and profound pancytopenia. Her first physical examination revealed an unconscious child with a Glasgow score of 11/15, generalized hypotonia, bleeding from the gum lining, facial erythrosis with peeling cheeks, hair loss (telogen effluvium), erythematous lesions ulcers of the anal margin, and fever. The myelogram performed two days after admission revealed a rich regenerative bone marrow with signs of inflammation. Besides, she developed deep vein thrombosis three days after placing her femoral catheter. Pancytopenia in hospitalized children is a rare but alarming situation. In our case, malignancy was excluded, as well as a severe infection. The cause of pancytopenia could be related to the toxic effects of Senna. Chronic use of Senna may be associated with bone marrow and liver toxicity and lead to deep vein thrombosis.

Hematological and biochemical abnormalities associated with severe forms of COVID-19: A retrospective single-center study from Morocco.

Since December 2019, the coronavirus disease (COVID-19) pandemic has catapulted the world into a marked health crisis, with over 29 million cases and >930,000 deaths. To better detect affected individuals at an early stage and stop disease progression to an advanced stage, several studies have been conducted to identify the clinical, biological, and radiological characteristics of COVID-19. This study aimed to enrich the literature by critically analyzing the clinical and biological characteristics of 134 patients from the North African Mediterranean region, including numerous genetic, epigenetic, and environmental factors that may influence disease evolution. This single-center retrospective study included all patients older than 18 years confirmed to have COVID-19 and hospitalized at the Cheikh Khalifa University Hospital affiliated with Mohammed VI University of Health Sciences, Casablanca, Morocco. Clinical, demographic, and biological data were analyzed in a cohort of severe and non-severe patients. Univariate analysis was performed to identify factors predictive of severity. There were 134 patients: the median age was 53 years, and 54.5% were male. Of these, 89 had mild to moderate disease; 45 had severe to critical disease, of which 14 died and 31 survived. Advanced age, presence of comorbidities, male sex, and infection in ethnic or family groups were risk factors for progression to severe disease. The presence of abnormalities in the following parameters were strongly associated with progression to severe disease: white blood cells (WBC), neutrophils, lymphocytes, C-reactive protein (CRP), procalcitonin, D-dimers, lactate dehydrogenase (LDH), ferritin, creatinine, aspartate aminotransferase (ASAT), and alanine aminotransferase (ALAT) during both admission and hospitalization. Based on these results and an extensive literature review, we recommend that clinicians closely monitor the biological parameters identified herein and perform immunological and genetic studies.

Primary Rhabdomyosarcoma of the Pleura: A Case Report and Review of the Literature.

Rhabdomyosarcoma is a malignant tumor of striated muscle tissue that can exceptionally present in the pleura. Its prognosis is generally poor. We report a case of an eight-year-old child admitted for a persistent dry cough which had progressed for three weeks, complicated by breathing difficulties and a deterioration in general condition. He had a history of recent contact with an uncle with pulmonary tuberculosis. Clinical examination on admission revealed right pleural effusion syndrome with moderate respiratory repercussion. The biological assessment shows moderate inflammation and a very high level of lactate dehydrogenase (LDH). Radiologically, there was abundant right pleurisy with intra-pleural nodular masses without ipsilateral pulmonary invasion or other distant localization. Pleural puncture reveals exudative lymphocytic fluid with negative tuberculous polymerase chain reaction (PCR) and atypical cells in cytology. Biopsy of the pleural mass showed pleural rhabdomyosarcoma of the alveolar type. The pet scan found bone metastases at two costal arches. After conditioning, the child received several courses of chemotherapy. The clinical and radiological outcome was favorable. This case is reported in view of its rarity and originality. We conclude that early diagnosis and treatment greatly improves the prognosis of this aggressive tumor.

Predictors of Severity in Covid-19 Patients in Casablanca, Morocco.

Background Morocco was affected, as were other countries, by the coronavirus disease 2019 (COVID-19) pandemic. Many risk factors of COVID-19 severity have been described, but data on infected patients in North Africa are limited. We aimed to explore the predictive factors of disease severity in COVID-19 patients in a tertiary hospital in Casablanca. Methods In this single-center, retrospective, observational study, we included all adult patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, admitted to Sheikh Khalifa International University Hospital in Casablanca between March 18 and May 20, 2020. Patients were separated into two groups: Non-severe patients were those with mild or moderate forms of COVID-19, and severe patients were those admitted to the intensive care unit (ICU) who had one of the following signs-respiratory rate > 30 breaths/min; oxygen saturation < 93% on room air; acute respiratory distress syndrome (ARDS); or required mechanical ventilation. Demographic, clinical, laboratory data, and outcomes were reviewed. We used univariable and multivariable logistic regression to explore predictive factors of severity. Results We reported 134 patients with confirmed SARS-CoV-2 infection. The median age was 53 years (interquartile range [IQR], 36-64), and 73 (54.5%) were men. Eighty-nine non-severe patients (66.4%) were admitted to single bedrooms, and 45 (33.6%) were placed in the ICU. The median time from illness onset to hospital admission was seven days (IQR, 3.0-7.2). Ninety-nine patients (74%) were admitted directly to the hospital, and 35 (26%) were transferred from other structures. Also, 68 patients (65.4%) were infected in clusters. Of the 134 patients, 61 (45.5%) had comorbidities, such as hypertension (n = 36; 26.9%), diabetes (n = 19; 14.2%), and coronary heart disease (n = 16; 11.9%). The most frequent symptoms were fever (n = 61; 45.5%), dry cough (n = 59; 44%), and dyspnea (n = 39; 29%). A total of 127 patients received hydroxychloroquine and azithromycin (95%). Eleven critical cases received lopinavir/ritonavir (8.2%). Five patients received tocilizumab (3.7%). We reported 13 ARDS cases in ICU patients (29%), eight with acute kidney injury (17.8%), and four thromboembolic events (8.8%). Fourteen ICU patients (31.1%) died at 28 days. In univariable analysis, older men with one or more comorbidities, infection in a cluster, chest scan with the COVID-19 Reporting and Data System (CO-RADS) 5, lymphopenia, high rates of ferritin, C-reactive protein (CRP), D-dimer, and lactate dehydrogenase were associated with severe forms of COVID-19. Multivariable logistic regression model founded increasing odds of severity associated with older age (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.01-1.09, P = .0039), men (OR 3.19, CI 1.06-9.60, P = .016), one or more comorbidities (OR 4.36, CI 1.32-14.45, P = .016), CRP > 10 mg/L (OR 5.47, CI 1.57-19.10, P = .008), and lymphopenia lower than 0.8 x109/L (OR 6.65, CI 1.43-30.92, P = .016). Conclusions Clinicians should consider older male patients with comorbidities, lymphopenia, and a high CRP rate as factors to predict severe forms of COVID-19 earlier. The higher severity of infected patients in clusters must be confirmed by epidemiological and genetic studies.

The epidemiological and clinical profile of COVID-19 in children: Moroccan experience of the Cheikh Khalifa University Center.

INTRODUCTION: COVID-19 is an infectious disease caused by a new coronavirus. The first cases were identified in Wuhan. It rapidly spread causing a pandemic worldwide. The incidence and severity of this disease are likely to be different in children compared with adults. Few publications of COVID-19 in children have been published. Our Moroccan paediatric series is among the first studies on this disease in Africa. METHODS: We included all children with COVID-19 who were admitted and treated at the hospital from March 25 to April 26, 2020. We have collected information, including demographic data, symptoms, imaging data, laboratory results, treatments and clinical progress from patients with COVID-19. RESULTS: Since the outbreak of 2019 novel coronavirus infection (2019-nCoV) in Morocco, a total of 145 COVID-19 confirmed cases have been reported in the Cheikh Khalifa's Hospital. Among this cases, 15 children were registered. The median age of patients was 13 years. There were 7 boys and 8 girls. Five children are asymptomatic, 8 have mild symptoms and 2 have a moderate respiratory difficulty. The RT-PCR test results were positive in all patients. Radiologically, we found in 2 cases, multiple nodules with ground-glass opacities on the chest scan. The treatment was based on the combination of hydroxychloroquine and azithromycin. Evolution under treatment was good for all patients. CONCLUSION: This study describes the profile of COVID-19 in child in a Moroccan hospital and confirms that the severity of illness in children with COVID-19 to be far less than adults.

A three-year-old boy with hypodipsic hypernatremia syndrome.

We describe a three-year-old boy who had a growth and psychomotor retardation associated with inappropriate lack of thirst and vasopressin secretion in the presence of chronic plasma hyperosmolarity. Computed brain tomography revealed bilateral supratentorial sub-ependymal and cortical calcifications. Dissociation in the plasma vasopressin response to osmotic change was demonstrated in this patient. Treatment with a vasopressin analogue, desamino-D-arginine vasopressin (DDAVP) and forced intake of water restored plasma osmolality and serum sodium levels to normal.