[Visceral leishmaniasis in adults: about twelve cases]. / La leishmaniose viscérale chez l'adulte à propos de douze cas.

Visceral leishmaniasis is a vector-borne disease essentially associated with Leishmania infantum infection in the Mediterranean basin. Although rare in adults, its prevalence has recently increased even among immunocompetent individuals. The aim of our study is to reveal the epidemiological features of visceral leishmaniasis in adults and the importance of biological diagnostic in the identification of this disease. Our study spanned six years from January 2009 to January 2014 and data were collected from twelve patients hospitalized at University Hospital Hassan II, Fez. Alteration of general state and splenomegaly dominated the clinical picture. Biologically, anemia was almost constant. Diagnosis was confirmed by parasite identification at the level of bone marrow. The response to treatment was favorable for all our patients. Thus, visceral leishmaniasis recrudescence in adults and its nonspecific clinical picture must lead the clinicians to suspect it when fever accompanying splenomegaly occurs, thus enabling early diagnosis and therapeutic management.

[Niemann Pick disease A: a case report]. / Maladie de Niemann Pick type A : à propos d'un cas.

The Niemann Pick disease is a rare lysosomal storage disease responsible for numerous cytological abnormalities of blood cells and bone marrow. The diagnosis requires enzymatic dosages, which can be long and difficult. In this context, the detection of inconstant cytologic anomalies in blood and bone marrow smears, allowing a rapid screening, is an important step in the diagnostic approach. We report the case of a 6 year-old child who presents with abdominal distension; medullogram was performed and revealed the presence of vacuolated cells overload. Correlated with clinical and biochemical data, medullogam results confirmed the diagnosis of type A Niemann Pick disease.

[Influence of urinary citrate levels on spontaneous calcium oxalate dihydrate crystalluria]. / Citraturie et cristallurie de weddellite.

INTRODUCTION: Calcium oxalate is the leading cause of renal stones and is mainly due to hypercalciuria, hyperoxaluria and/or hypocitraturia. Citrate is considered to be an effective inhibitor of calcium oxalate crystallization and is therefore increasingly prescribed as maintenance therapy for patients with calcium stones, but no study has investigated the effect of urinary citrate levels on spontaneous calcium oxalate crystalluria in human urine. In this study, the authors examined the relationships between the calcium oxalate molar product, the urinary citrate concentration and weddellite (oxalate calcium dihydrate) crystalluria, the most frequent crystalline form of calcium oxalate in human urine. MATERIAL AND METHODS: Crystalluria analysis and calcium, oxalate and citrate assays were performed on a series of 10,222 first morning urine samples from 4,809 stone patients and 453 first morning urine samples from 317 control subjects. The frequency and characteristics of weddellite crystalluria were determined as a function of the calcium oxalate molar product (pCaOx) and urinary citrate concentration. RESULTS: 1,940 urine samples (18.2%) presented weddellite crystalluria, which was pure in 1,378 urine samples from stone patients (13.5%) and 43 urine samples (9.5%) from controls (p < 0.05). The crystalluria rate in stone patients ranged from 4% for pCaOx < 1 (mmol/l)2 to 81.3% for pCaOx > or = 3 (mmol/l)2 (p < 0.0001). Over the same interval of pCaOx, weddellite crystalluria ranged from 1.5% to 72.2% in control subjects. An increase of urinary citrate excretion from 0.5 to 5 mmol/l significantly lowered the frequency of crystalluria from 32.4% to 10.1% for a pCaOx between 1 and 2 (mmol/l)2 (p < 0.0001) and from 63% to 27.9% for a pCaOx between 2 and 3 (mmol/l)2 (p < 0.001). For pCaOx values > or = 3 (mmol/l)2, urinary citrate excretion no longer significantly influenced the frequency of crystalluria. The number of crystals and aggregates and the maximum dimensions of aggregates were only influenced by the urinary citrate concentration when the pCaOx product was < 2 (mmol/l)2. CONCLUSION: The main determinant of the frequency and characteristics of weddellite crystalluria is the pCaOx molar product. The beneficial effect of the urinary citrate concentration on the frequency of crystalluria is observed for pCaOx values < 3 (mmol/l)2, but only for pCaOx values < 2 (mmol/l)2 for the characteristics of crystalluria such as the number and dimensions of crystals and aggregates. This means that therapeutic measures designed to increase urinary citrate concentrations can only be effective when pCaOx has been previously lowered by increased diuresis or specific reduction of urinary calcium and/or urinary oxalate levels.