Screening for childhood lead poisoning in the industrial region of Fez, Morocco.

The study objectives were to estimate lead poisoning prevalence among children living next to an industrial area, to compare it to that in a control population, and to establish clinical and biological follow-up of the poisoned children. This is a descriptive cross-sectional study including 150 children (exposed and unexposed) performed between January 2012 and April 2013. It was meant to determine blood lead levels (BLLs) in children considered to be an exposed population (EP N 90), living in the industrial area Ain Nokb Fez compared with BLLs of children of other areas belonging to the same city supposed to be unexposed [UP (N = 60)]. A sociodemographic questionnaire was obtained, and a blood lead analysis was performed. Clinical and biological follow-up has been performed of poisoned children. The sample consisted of 90 EP children with an average age of 6.82 ± 3.32 years and male-to-female sex ratio (SR) of 1.5 and 60 UP children with an average age of 6.45 ± 3.29 years and an SR of 1.2. Among the 150 children recruited, the average of BLLs was 58.21 ± 36 µg/L (18-202.3 µg/L). The average of BLLs in EP children (71 ± 40 µg/L) was statistically greater (p < 0.0001) than that registered in UP children (38 ± 13 µg/L). All poisoned children belonged to the EP group at a prevalence of 21.1 %. The clinical and biological examinations of poisoned children showed a few perturbations such as anemia, hypocalcaemia, and deficiencies in magnesium and iron. No renal disease or objective neurological disorders were observed. In the follow-up of the children with BLL ≥100 µg/L (19 cases). BLL monitoring showed a significant decrease in average of blood concentration ranging from 136.75 ± 32.59 to 104.58 ± 32.73 µg/L (p < 0.0001) and in lead poisoning prevalence (p < 0.001), which decreased to 7.8 % from 21.1. Our study showed a high prevalence of lead poisoning (21.1 %) in EP children. The relocation of the industrial site associated with corrective and preventive measures has contributed to a decrease of exposure and lead poisoning prevalence in the aforementioned population.

[Seizures revealing phosphocalcic metabolism abnormalities]. / Crises épileptiques révélant des anomalies du métabolisme phosphocalcique.

Hypocalcemia due to hypoparathyroidism produces a broad spectrum of clinical manifestations, but overt symptoms may be sparse. One unusual presentation is onset or aggravation of epilepsy in adolescence revealing hypoparathyroidism. This situation can lead to delayed diagnosis, with inefficacity of the antiepileptic drugs. We report five cases of adolescence-onset epilepsy with unsuccessful antiepileptic therapy, even with gradually increasing dose. Physical examination revealed signs of hypocalcemia, confirmed biologically. Full testing disclosed the origin of the seizures: hypoparathyroidism in three patients and pseudohypoparathyroidism in the other two. In four of five patients, computed tomography showed calcification of the basal ganglia, defining Fahr's syndrome. The patients were treated with oral calcium and active vitamin D (1-alphahydroxy vitamin D3). Seizure frequency progressively decreased and serum calcium levels returned to normal. These cases illustrate the importance of the physical examination and of routine serum calcium assay in patients with new-onset epileptic seizures in order to detect hypocalcemia secondary to hypoparathyroidism.

[Osteomyelitis of the mandible and dysosteosclerosis]. / Dysostéosclérose et ostéite chronique de la mandibule.

Dysosteosclerosis is a rare genetic disorder with a poor prognosis. It is an osteochondrodysplasia similar to osteopetrosis but it is typically characterized by platyspondyly and expanded metaphyses. It shows complications such as compression of cranial nerves, especially the optic nerve, hematologic complications, fractures following mild injury, abnormal dentition, neurological and psychological deterioration, in addition to osteomyelitis of the mandible. We report a new case of dysosteosclerosis complicated by osteomyelitis of the lower maxilla.

[Hypercalcemia complicating BCG lymphadenitis: case report]. / Hypercalcémie compliquant une bécégite locorégionale : à propos d'un cas.

One of the side effects of the BCG vaccine is a local infection that may spread to the regional lymph nodes causing lymphadenitis, which can resolve spontaneously without treatment. We report the case of an immunocompetent infant who developed lymphadenitis after administration of the BCG vaccine, complicated with persistent symptomatic hypercalcemia in spite of the usual treatment including corticotherapy. Antituberculous treatment was necessary to reduce this hypercalcemia.

[Aneurysm of the internal saphenous vein: report of a case]. / Anévrisme de la crosse de la veine saphène interne: à propos d'un cas.

Venous aneurysms of the lower extremities are rare. They have been reported in both the deep and superficial vein system. Thromboembolism is more common in aneurysms involving the popliteal vein than those involving superficial veins. We report a case of primary aneurysm of the greater saphenous vein presenting as an inguinal hernia. Sonography has confirmed the venous dilatation. we review also the clinical and therapeutic findings of venous aneurysms of the lower extremities.

[The contribution of transfontanellar ultrasound in the early diagnosis of neonatal cerebral venous thrombosis: report on three cases]. / Apport de l'échographie transfontanellaire dans le diagnostic précoce des thromboses veineuses cérébrales néonatales : à propos de trois cas.

The clinical aspects of neonatal cerebral venous thrombosis are polymorphic in their mode of onset, making diagnosis difficult. Transfontanellar ultrasound allows for the morphological and vascular exploration of intracranial contents. We report three cases of neonatal cerebral venous thrombosis diagnosed early by transfontanellar ultrasound. The patients were treated with low-molecular-weight heparin, and the outcome was favorable in all three newborns. Transfontanellar ultrasound has a variable sensitivity for the detection of thrombus, but it remains the first-line examination before any additional secondary exploration. The early diagnosis of neonatal cerebral venous thrombosis with transfontanellar ultrasound requires the implementation of emergency treatment.

Molecular defects in Moroccan patients with ataxia-telangiectasia.

Ataxia-telangiectasia (AT) is a rare autosomal recessive disease, affecting neurologic and immune system. Numerous mutations are described in the ATM gene in several populations. However, in Morocco, few data are available concerning this condition. Our main goal is to determine clinical, immunological, and molecular presentation of Moroccan patients with AT. We screened 27 patients, out of 22 unrelated families, for ATM gene mutations. All our patients showed ataxia, ocular telangiectasia, and immunodeficiency, as well as elevated serum alphafetoprotein levels. Mean age at diagnosis was 5.51 years, and consanguinity rate was 81.8 %. Mean age at onset was 2.02 years, and mean time to diagnosis was 3.68 years. We found 14 different mutations in 19 unrelated families, of which 7 were not reported. Our results showed that c.5644C>T mutation was the most common in our series. However, further studies are required to demonstrate a founder effects on ATM gene in Moroccan patients, who showed mutational heterogeneity otherwise. Our data indicate that direct sequencing of coding exons is sufficient for a high detection rate in ATM in Moroccan population.

[Pseudothrombotic microangiopathy related to vitamin B(12) deficiency]. / Pseudo-microangiopathie thrombotique liée à un déficit en vitamine B12.

Vitamin B(12), or cobalamin, deficiency is often unrecognized because the clinical manifestations are subtle; they are also potentially serious. We report a case of pseudothrombotic microangiopathy related to cobalamin deficiency. Vitamin B(12) deficiency, which is more commonly recognized in the context of malnutrition, should be considered in the context of microangiopathy.

[Periodontal diseases with Entamoeba gingivalis]. / Parodontopatii cu Entamoeba gingivalis.

At the beginning of our century Entamoeba gingivalis was considered to be a pathogenic bacteria, capable to induce parodontal lesions. Later on it was also found in healthy persons, and the germ was less interesting from the medical view-point. In the present study the authors report their findings concerning E. gingivalis in 135 patients with various stomatological affections including: dental caries, parodontopathies, pulpitis, gangrene, ulcero-necrotic stomatitis etc. The study was started following the discovery of the amoeba in the gingival exsudate of a male aged 19 years with chronic superficial marginal parodontopathy, who, after a treatment with metronidazol, was cured. Entamoeba gingivalis belongs to the Rhizopoda class, together with E. dysenteriae, and E. coli, but, in contrast with these strains it does not have resistance forms (cysts). Oral amoeba were evidenced in 18 out of 78 patients with parodontal lesions (23.07%), in the gingival exsudate, the purulent secretion from parodontal pouches, in the dental tartar, the alveolar fluid following extraction etc. In 117 students from the Faculty of Stomatology, and in 57 patients with various other stomatological affections these germs were not found in any of the abovementioned products. Microscopic examination of fresh preparations, and of Giemsa-stained smears was the main method for the detection of the amoeba. The etiopathogenic role of E. gingivalis is re-examined in discussions regarding certain parodontopathies.

[Giant aneurysm of the inter-atrial septum]. / Anévrisme géant du septum inter-auriculaire.

We report the case of a large atrial septal aneurysm and a review of the literature. Atrial septal aneurysm is found in 1-8% of normal subjects. Its prevalence is higher among patients with ischemic stroke. Transesophageal echocardiography is an optimal tool for the diagnosis of atrial septal aneurysm. The clinical course may be complicated by arterial embolism, but mechanical complications may also occur, as in this case. Due to the lack of general agreement, treatment options should be discussed on an individual basis for patients with atrial septal aneurysm.

Epidemiological and clinical characteristics of scorpion stings in children in Fez, Morocco

Scorpion stings are a public health problem in Morocco, especially among children, who experience the most severe cases. Epidemiological and clinical findings on scorpion stings in Fez, Morocco, were evaluated in this investigation. Of 163 cases that required medical attention, 62.6 percent were male children. The mean age of patients was 4.8 ± 3.4 years. The mean time between stings and first medical attention was 3.36 ± 2.5 hours. Almost all cases occurred in the summer (94 percent) and extremities represented the most frequent sting sites (86.5 percent). Local pain, hyperemia, scarification, vomiting, sweating, restlessness, tachycardia and tachypnea were the observed clinical symptoms. Regarding severity, 55.2 percent of patients belonged to class III, followed by class II (26.4 percent) and class I (18.4 percent). None of our patients received antivenom; however, all of them were treated symptomatically depending on clinical manifestations.(AU)