[Early surgery in infective endocarditis. Retrospective study apropos of 30 cases]. / Chirurgie précoce dans l'endocardite infectieuse. Etude rétrospective à propos de 30 cas.

AIM: The aim of this study is to stress the interest of the early surgery in infective endocarditis (IE), its indications and prognostic implications. METHODS: It is a retrospective descriptive study of 30 cases (29 men and 1 woman with an average age of 35+/-12 years) with IE underwent surgery management in the acute phase between September 1993 and June 2005. RESULTS: They were 25 rheumatic lesions, 2 aortic bicuspids and 3 mechanical valves prosthesis. Four twenty-six percent of the patients were operated for hemodynamic deterioration and 10% for embolic complication. We report 3 cases (that is to say 10%) of IE late form on prosthesis. Three patients died in the first post operative month by respectively total desinsertion of mitral prosthesis on peroperative, 1 septic shock at the 13th post operative day and 1 tamponade at the 14th postoperative day. On 72 months an average follow-up, 26 were controlled regularly: 25 evolved favourably and 1 died in third postoperative year (severe heart failure). CONCLUSION: A high early surgery rate is related to good long term results and does not increase in hospital mortality. The reduced mortality was particularly evident among patients with moderate to severe congestive heart failure.

Analysis of HCV co-infection with occult hepatitis B virus in patients undergoing IFN therapy.

BACKGROUND/AIM: Occult hepatitis B virus (HBV) infection is characterized by the presence of HBV DNA in the absence of hepatitis B surface antigen (HBsAg) in the patient serum. Although such infections have been identified in patients with chronic hepatitis C, the clinical significance of those co-infections is still not understood. Our aim was, therefore, to assess the prevalence and clinical consequences of occult HBV infection in chronic hepatitis C patients undergoing antiviral therapy. METHODS: The study population consisted of 53 HBsAg-negative patients with chronic hepatitis C treated with IFN/ribavirin or IFN/ribavirin/amantadine. Nine patients experienced a viral breakthrough (BT), 30 were non-responders (NR) and 14 were responders (R). HBV-DNA detection by PCR was performed using primers specific for the S region of the HBV genome and HCV-RNA detection by PCR with primers localised in both the 5'NC and core region of HCV genome, before, during and after treatment. Viral genome sequences were also studied. RESULTS: Occult HBV genomes were found in the serum of four of 53 (7.5%) patients, unrelated to anti-HBc status. No significant differences in biochemical, virological, or histological markers, age, duration of infection, were observed in patients with or without HBV DNA. There was an inverse correlation in the evolution of HBV DNA and HCV RNA levels. Direct sequencing showed that S gene of occult HBV presented mutations in the "a" determinant while no specific mutation in the core region of HCV was observed. None of the four patients co-infected with HBV and HCV were responders to anti-HCV therapy. CONCLUSION: In our clinical setting, the prevalence of occult HBV co-infection among patients with chronic hepatitis C was low and independent of the presence of markers of previous HBV infection. Further studies in larger cohort of patients are warranted to determine if occult HBV co-infection may be involved in HCV resistance to combination therapy.

[Usefulness of microalbuminuria in the metabolic syndrome as a predictor of cardiovascular disease. Prospective study about 78 cases]. / Intérêt de la microalbuminurie au sein du syndrome métabolique dans la prédiction des évènements cardiovasculaires. Étude prospective à propos de 78 cas.

AIM: Increased urinary albumin-excretion is a cardiovascular risk factor. The metabolic syndrome is associated with an increased risk of chronic kidney disease, cardiovascular disease and mortality. The aim of this prospective study was to explore the combined associations of microalbuminuria and metabolic syndrome with the risk of incident cardiovascular disease. METHODS: The present study involved 78 patients with metabolic syndrome between May 1 and July 30 in 2009 from cardiology clinic of military hospital in Marrakech. They were followed for 1 year. The metabolic syndrome was defined according to the criteria of International Diabetes Federation (IDF). Microalbuminuria was defined as a urinary albumin excretion of 30 to 300mg/d. RESULTS: The mean age was 56 years old. The prevalence of microalbuminuria was 38%. There was a significantly positive correlation between the number of components of the metabolic syndrome and the corresponding prevalence of microalbuminuria. Incidence rates of cardiovascular events were higher in the positive microalbuminuria group than the group without microalbuminuria, the difference was significant for composite criteria but not for each one probably because of the small size of effective and limited duration. CONCLUSIONS: There is a strong relationship between microalbuminuria and the metabolic syndrome. Microalbuminuria accounts for the increased risk of cardiovascular disease in patients with metabolic syndrome.

Range-reference determination of lymphocyte subsets in Moroccan blood donors.

BACKGROUND: Information on lymphocyte populations (T, B, and Natural killer cells) and subpopulations (CD4 and CD8) in Morocco is scarce if not inexistent. OBJECTIVE: To establish a reference value of these cells in 242 Moroccan young adult blood donors by flow cytometry. RESULTS: Smokers had significantly higher total leukocyte count (p < 0.001), total lymphocyte count (p < 0.0001) and higher CD3+CD4+ cells (p < 0.0001). The percentage of CD3-CD56+ subsets was affected by smoking (p < 0.01). Our analysis positively correlate with previous observations of an increase of absolute CD4+ T cells, with no changes in other lymphocyte subset cells in smokers. The lymphocyte subpopulation distributions for all antigens were found to be similar to those reported in Saudi and Italian adults, while higher levels were reported for the same gender in other countries, especially Ghana and Kuwait. CONCLUSION: The international classification standards of the HIV-infected subjects according to their rates of CD4 are applicable to the present study's population.

Occult HBV infection may represent a major risk factor of non-response to antiviral therapy of chronic hepatitis C.

Occult hepatitis B virus (HBV) infection is common in chronic hepatitis C patient. However, its significance and consequences are still unclear. The aim of this study was to evaluate the prevalence of occult HBV among HCV chronic carriers in France and to assess its impact on liver histology and response to antiviral therapy. To this end a cohort of 203 patients with chronic hepatitis C without hepatitis B surface antigen (HBsAg) has been examined. Serum HBV-DNA was detected using a highly sensitive PCR with primers located in the S and X genes. HBV viraemia levels were further determined by real-time PCR. Results showed that 47 of 203 (23%) patients had occult HBV infection with a low HBV load (10(2)-10(4) copies/ml) but significantly higher HCV-RNA titers (P < 0.05). No significant difference in age, gender, serum ALT level, HCV genotypes, and the presence of anti-HBc was observed between patients with or without HBV-DNA. When compared histologically, patients with occult HBV infection had higher activity (A2-A3 in 53% vs. 38%, P < 0.01) and more advanced fibrosis (60% vs. 33%, P < 0.001) than HBV-DNA negative cases. Sustained response to combination therapy against Chronic hepatitis C was achieved in 11 (28%) of 40 HBV-DNA positive cases, compared with 65 (45%) of the 144 HBV-DNA negative cases (P < 0.05). Among the 144 HBV-DNA negative HCV patients those with genotype 1 responded less frequently to therapy as compared to other genotypes infected patients (38% vs. 55%, P < 0.05). Surprisingly, when considering all patients studied, irrespective to the HBV-DNA status no significant difference was observed in response to combination therapy regarding HCV genotypes (39% vs. 44%, P > 0.05). In conclusion, HBV-DNA is found in 1/4 of French chronic hepatitis C patients regardless of the presence of anti-HBc. Such an occult HBV co-infection is associated with more severe liver disease, higher HCV viral load and decreased response to antiviral therapy irrespective of HCV genotypes.