COVID-19 associated Kawasaki-like multisystem inflammatory syndrome in an adult.

Recently, few reports have described a serious condition linked to SARS-CoV-2 that mimics Kawasaki disease called multisystem inflammatory syndrome, especially in children (MIS-C) and young adults. In this work, we report on a severe form of MIS in a young female adult previously infected by SARS-CoV-2. She was treated by plasmapheresis with albumin and steroids, however outcome was fatal. We discuss the pathogenesis of this rare and life threatening entity and suggest some therapeutic regimen. This syndrome should not be misdiagnosed with an infectious or a drug induced cutaneous rash in the current context of COVID-19 pandemic.

[COVID-19 associated Kawasaki-like multisystem inflammatory syndrome in an adult]. / Síndrome inflamatorio multisistémico de tipo Kawasaki asociado a COVID-19 en un adulto.

Recently, few reports have described a serious condition linked to SARS-CoV-2 that mimics Kawasaki disease called Multisystem inflammatory syndrome, especially in children (MIS-C) and young adults. In this work, we report on a severe form of MIS in a young female adult previously infected by SARS-CoV-2. She was treated by plasmapheresis with albumin and steroids, however outcome was fatal. We discuss the pathogenesis of this rare and life threatening entity and suggest some therapeutic regimen. This syndrome should not be misdiagnosed with an infectious or a drug induced cutaneous rash in the current context of COVID-19 pandemic.

COVID-19 associated Kawasaki-like multisystem inflammatory syndrome in an adult. / Síndrome inflamatorio multisistémico de tipo Kawasaki asociado a COVID-19 en un adulto.

Recently, few reports have described a serious condition linked to SARS-CoV-2 that mimics Kawasaki disease called Multisystem inflammatory syndrome, especially in children (MIS-C) and young adults. In this work, we report on a severe form of MIS in a young female adult previously infected by SARS-CoV-2. She was treated by plasmapheresis with albumin and steroids, however outcome was fatal. We discuss the pathogenesis of this rare and life threatening entity and suggest some therapeutic regimen. This syndrome should not be misdiagnosed with an infectious or a drug induced cutaneous rash in the current context of COVID-19 pandemic.

Evaluation and management of thromboprophylaxis in Moroccan hospitals at national level: the Avail-MoNa study.

Venous thromboembolism (VTE) is a common clinical problem that is associated with substantial morbidity and mortality. The aim of this study was to describe the clinical practices in VTE prophylaxis in university and peripheral hospitals in Morocco. This is a national, cross-sectional, multicenter, observational study assessing the management of the VTE risk in selected Moroccan hospitals (four university and three peripheral). The thromboembolic risk of the selected patients was assessed according to the American College of Chest Physicians (ACCP) guidelines (2008). We hypothesized that interventions for VTE guideline implementation in those hospitals may improve prophylaxis use for hospitalized patients. A total of 1318 patients were analyzed: 467 (35.5%) medical and 851 (64.5%) surgical. The mean age of patients was 52.6 ± 16.5 years, and 52.7% were female. A total of 51.1% patients were considered to be at risk of VTE according to ACCP guidelines and were eligible for thromboprophylaxis (TP). Medical patients were more likely to present risk factors than surgical patients (53.6 vs. 50.7%, respectively). TP was prescribed for 53.1% of these patients, 57.4% in at-risk surgical patients and 50.3% in at-risk medical patients. TP was also prescribed for 42.9% of non-at-risk patients. The concordance between the recommended and the prescribed prophylaxis was poor for the total population (kappa = 0.110). TP did not improve sufficiently in our hospitals, even after implementation of the guidelines. New strategies are required to appropriately address TP in hospitalized patients.

Cardiac arrest after tourniquet deflation in upper limb.

Pneumatic tourniquet is a technique widely used in orthopedic surgery, in particular, for reducing intraoperative bleeding and facilitation of surgery. That said, it may cause local and systemic complications which can be life-threatening. The description of this kind of complications is usually made after lower limb utilization. We report the case of a patient, operated for fractures of the two upper limbs, who presented after the second tourniquet deflation, a cardiac arrest with a good recovery after cardio-pulmonary resuscitation. The most likely cause of this cardiac arrest, is the ischemia reperfusion syndrome caused by successive excessively inflated tourniquet, since pulmonary embolism and myocardial infarction are eliminated. In the light of this exceptional clinical observation, we insist on the respect of usual recommendations of use, such as duration and inflation pressure, especially when successive upper limbs tourniquets are used.

[Anthrax meningoencephalitis: a case following a cutaneous lesion in Morocco]. / Atteinte cérébroméningée de la maladie de charbon: à propos d'un cas à point de départ cutané au Maroc.

Anthrax meningoencephalitis is very rare especially following skin location. We report a case of meningoencephalitis secondary to skin lesion. The diagnosis is based on clinical presentation and confirmed by microbiological tests. Its evolution remains fatal despite aggressive resuscitation.

[Ischemic stroke following a scorpion sting]. / AVC ischémique suite à une morsure de scorpion.

Scorpion envenomation is caused by an accidental scorpion sting. In its severe form, it involves life-threatening respiratory or cardiac damage; it may also cause the neurological severity of systemic manifestations. We report the case of a young 35-year-old woman stung by an Androctonus mauretanicus scorpion, who developed impaired consciousness, hemiplegia and respiratory distress. At admission, the brain computed tomography showed a hypodense area in the right parietal region; the chest radiograph revealed a bilateral alveolar syndrome. Troponin was elevated and hemostasis disorders were present. The clinical course was remarkable: cardiogenic shock with multiple organ failure followed by death on day 3. This case illustrates a rare complication of scorpion envenomation: ischemic stroke due to an undetermined mechanism, which in addition to the cardiac and respiratory injuries, led to the serious complications and fatal outcome.

[Fingers amputation following snakebite: a report of three cases]. / L'amputation des doigts par morsure de serpent : à propos de trois cas.

The amputation of the finger complicating an ophidian bite is rare. It is due to virulence of the venom, its concentration in a small volume of tissue and use of a tourniquet. Support of the victim seeks to save his life and function of his(her) hand. Antivenin immunotherapy is the only specific treatment for ophidian envenimation. It is indicated in case of general signs showing a serious bite, but also if local signs could lead to loss of limb function. The authors report three cases of snakebite complicated by amputation of a finger.

[Hydatid cyst of the thyroid in a child]. / Kyste hydatique de la thyroïde chez l'enfant.

INTRODUCTION: Hydatidosis is an anthropozoonosis due to the development of the Echinococcus granulosus in humans. Thyroid gland involvement is rather rare. The authors report a very rare case of thyroid gland hydatidosis in a child. OBSERVATION: A 6-year-old male child presented with an isolated neck mass. Cervical ultrasonography suggested a cystic thyroid nodule. No invasive investigation was performed. Hepatic ultrasound and chest radiography were normal. Hydatid serology was negative. The tumor was en-bloc removed by cervicotomy. Its content was fluid, crystal clear, with membranes confirming the hydatid origin. There was no recurrence after 9 months. DISCUSSION: Even though hydatidosis in the thyroid is rare, it should be considered in case of anterior cervical tumor, for patients living in endemic zones. The only radical treatment is surgery. An en-bloc resection must be performed with a cystectomy, isthmolobectomy, or total thyroidectomy.

[A prospective randomized comparison of nebulized morphine versus thoracic epidural analgesia in the management of thoracic trauma]. / Comparaison prospective et randomisée de la morphine nébulisée versus la péridurale thoracique dans la prise en charge de la douleur des traumatisés thoraciques.

INTRODUCTION: Successful management of pain reduces morbidity and improves patient satisfaction of patient after a chest trauma. The purpose of the study was to evaluate the efficacy of the respiratory administration of nebulized morphine in such patients. PATIENTS AND METHODS: Patients were included in this prospective and randomized study patients to receive either nebulized morphine in group M or a mixture of bupivacaine-fentanyl by epidural route. In group M, patients received nebulized morphine every 30 minutes until the second hour then every 4 hours during 48 hours. In the thoracic epidural analgesia group (group P) they received a mixture of 0.125% bupivacaine and 0.115% of fentanyl continuously infused at the rate of 7 ml/h during 48 hours. The main criterion of judgment was the analgesic effects of analgesic regimen with EVA < 4. Sedation, haemodynamic and respiratory parameters were continuously recorded, as adverse side effects were they occurred. Statistical comparisons were performed with Chi(2), Fisher or Student t-test when appropriate (p<0.05). RESULTS: Forty patients were randomized in two groups. Groups were not different regarding the demographic parameters. Analgesia was effective in both groups (NS). Sedation, hemodynamic and respiratory parameters were not different between groups. No side effect was noted in groups. CONCLUSION: Nebulized morphine was an analgesic technique as effective as epidural bupivacaine-fentanyl in our series. This non-invasive route of administration of morphine appears to be useful to treat pain after a chest trauma.

[Pneumocystis jiroveci pneumonia in an immunocompetent female patient]. / Pneumopathie à Pneumocystis jirovecci chez une patiente immunocompétente.

Pneumocystis jirovecci is an opportunist fungal agent that usually causes pneumonia in immunocompromised patients, particularly those presenting with AIDS. In rare cases, this fungus can cause pneumonia in immunocompetent patients. The symptomatology in this case is acute and fulminant. We report the case of a Pneumocystis jirovecci pneumonia in a young patient initially admitted for acute respiratory distress. This case is unusual since all the exams performed to screen for immune deficit were negative. The diagnosis was made after identifying Pneumocystis jirovecci cysts in broncho-alveolar lavage.