Parathyroid adenoma with concurrent toxic thyroid adenoma: a rare combination.

BACKGROUND: Hypercalcemia in association with hyperthyroidism is a well-recognized phenomenon. Primary hyperparathyroidism due to parathyroid adenoma in association with thyroid adenoma is extremely rare. These cases can present a diagnostic and therapeutic challenge to the treating physician as the patient may present with symptoms of either disease. CASE SUMMARY: A 47-year-old female patient presented with non-specific complaints including fatigue and muscle cramps. Diagnostic workup revealed significantly elevated plasma calcium levels in association with hyperthyroidism. There was a considerable delay in measuring the parathyroid hormone levels which were significantly elevated. Nuclear medicine studies revealed features consistent with a parathyroid adenoma and a concurrent thyroid adenoma. The patient was rendered euthyroid and subsequently taken to theatre for a thyroid lobectomy and removal of the associated parathyroid adenoma. One year later the patient remains normocalcemic, euthyroid and clinically well. CONCLUSION: Toxic thyroid adenoma with concurrent parathyroid adenoma and primary hyperparathyroidism is rare. The possibility of primary hyperparathyroidism should be considered where hypercalcemia persists on correcting the hyperthyroidism. Removal of both adenomas will result in cure of the patient.

Effect of Montanide™ IMS 1312 VG adjuvant on efficacy of Yersinia ruckeri vaccine in rainbow trout (Oncorhynchus mykiss).

The efficacy of immersion vaccination Yersinia ruckeri bacterin containing Montanide™ IMS 1312 VG was evaluated in 100-120 g rainbow trout against yersiniosis. Healthy fish were vaccinated by immersion vaccination with inactivated whole cells (1 × 10(8) cells/ml) of a virulent strain of Y. ruckeri biotype I with and without Montanide (1:1; Montanide/antigen) for 2 min at 12-14 °C. Control group was immersed in sterile PBS. Leukocyte counts, serum lysozyme assay, alternative hemolytic complement (ACH50) assay, antibody titration and relative percent survival (RPS) were measured on 2-10 weeks post-immunization. No significant difference was seen in leucocyte population of trout immunized either with Y. ruckeri antigen or Y. ruckeri antigen containing Montanide (P > 0.05), while leucocyte and heterophil populations in control group were significantly lower and higher, respectively, than both immunized groups (P < 0.05). In addition, there was no significant difference in lymphocyte population of trout immunized either with Y. ruckeri antigen or Y. ruckeri antigen containing Montanide (P > 0.05), while lymphocyte population in control group was significantly lower than both immunized groups (P < 0.05). Lysozyme activity in immunized fish with Y. ruckeri containing Montanide was higher than the immunized fish with Y. ruckeri antigen alone during 8 weeks post-immunization ((P < 0.05). Also, level of lysozyme in control fish was generally lower than both immunized groups (P < 0.05). The level of ACH50 between both immunized groups was insignificant (P > 0.05) but these were significantly higher than control group through the experiment (P < 0.05). The lowest anti-Y. ruckeri antibody titers in both immersion vaccination groups were significantly higher through 2-8 weeks post-vaccination compared to the control group (P < 0.05). In the group immersion vaccinated with Y. ruckeri bacterin plus Montanide the titers 2-8 weeks post-vaccination were significantly higher the titer in the immersion vaccinated with Y. ruckeri bacterin (P < 0.05). Fish vaccinated with antigen without Montanide resulted in RPS of 80-82% on 2-10 weeks post-vaccination, while those for antigen containing montanide gave RPSs of 93.8-100% 2-10 weeks post-immunization (P < 0.05).

Hepatitis B in Moroccan blood donors: a decade trend of the HBsAg prevalence in a resources limited country.

OBJECTIVES: To calculate the hepatitis B surface antigen (HBsAg) reactive rate for 2011 blood donors (BD) across Morocco. In addition, to monitor the profile of donors bearing the HBsAg during 2000 and 2011, we calculated the percentage of the prevalence in both sexes, in different age groups and in first-time replacement and regular BD from the Rabat Regional Blood Transfusion Centre. BACKGROUND: Hepatitis B is a viral infection that spreads through blood and other biological fluids. The hepatitis B virus remains one of the most common serious complications of transfusion. No information exists on the real prevalence of hepatitis B in Moroccan BD. METHODS: For the 2011 national HBsAg reactive rate, the percentage was calculated based on enzyme-linked immunosorbent assay (ELISA) results of the 232 190 blood donations collected around the country. For the Rabat blood Centre, we calculated the hepatitis B sero-prevalence from donations made at the donors' suite during 2000 and 2011. RESULTS: The national prevalence of HBsAg was 1·34%. The HBsAg variations among different regions was between 0·43 and 2·86%. The Rabat donors' suite hepatitis B prevalence decreased from 2·47% in 2000 to 0·91% in 2011 (P < 0·001). In both years, family/replacement donors were found as safe as first-time BD and female donors were the safest. CONCLUSIONS: These results, presented for the first time in the country, mapped the hepatitis B distribution across Morocco in a healthy population. The findings of this study could be of great importance in setting up strategies for the recruitment of the BD and keeping blood safety at the highest level.

[Description of poisoning reported in Marrakech-Tensift-Al Haouz region in Morocco between 1981 and 2008]. / Description des intoxications notifiées dans la région de Marrakech-Tensift-Al Haouz au Maroc entre 1981 et 2008.

In Morocco, the Marrakech-Tensift-Al Haouz region is one of the 16 regions most affected by poisoning. The aim of this study was to determine the epidemiological profile of poisoning recorded in the study region. A retrospective study of poisoning cases, declared between 1981 and 2008 in the Morocco Poison Control and Pharmacovigilance Center, was conducted. During the study period, 8517 poisoning cases were collected. The average age of patients was 22 ± 15 years. The male/female sex ratio was 0.85. Food poisoning was the most reported in the region, with 26.6% of cases. Among the 2,779 patients for whom the outcome was known, 65 died, with lethality rate of 23.4‰. The maximum lethality rate was recorded among those poisoned by paraphenylenediamine (170.7‰).

Prognostic factors of Atractylis gummifera L. poisoning, Morocco.

In Morocco, acute Atractylis gummifera L. poisoning represents the leading cause of death by plant poisoning especially for children. All cases received in the Moroccan poison control centre from January 1981 to December 2009 (n = 467) were included in a retrospective study of the characteristics and risk factors of A. gummifera L. poisoning. The most vulnerable age group was children (63.4% of cases). Most cases were due to accidental exposure (75.5%), but some were from therapeutic use (18.1%) or attempted abortion (7.4%). Patients presented with moderate poison severity signs (grade 2) in 22.3% of cases or severe signs (grade 3) in 21.0%. The mortality rate was 39.2%. The majority of deaths (81.1%) occurred in children aged < 15 years following accidental exposure. Multivariate logistic regression analysis revealed that risk factors for mortality were coma (OR = 20.5); hepatitis (OR = 52.7) and rural residence (OR = 7.26), while gastric decontamination was a protector factor (OR = 0.26).

Blood donation in Morocco: a 20-year retrospective study of blood collection in the Rabat blood centre.

OBJECTIVES: We trace the history of blood donors and the recruitment strategies developed between 1988 and 2008 in the regional blood transfusion centre of Rabat. Beside, we draw a distribution map of the blood donors' population in Morocco during the year 2008. BACKGROUND: Limited resource countries face considerable obstacles to ensuring a safe blood supply and safe blood transfusions. Many countries used and some of them still depend on replacement blood donors. METHODS: Data published in this article had been collected from the CRTS of Rabat archives and reports. Data from all the 16 regional blood transfusion centres were collected from the report annually presented by the different regions. RESULTS: We found that during the 20 years period studied, the number of blood units collected by Rabat recorded many fluctuations. In the mean time, many measures were taken to promote the recruitment of voluntary blood donors. The proportion of these later jumped from 16·55% in 1988 to reach almost 80% in 2008. Beside, the whole country's blood collection map for the year 2008 showed that 190 504 of whole blood units were collected. This means that there are only six donations per 1000 people. CONCLUSION: This is the first study conducted in Morocco that provided detailed information on ongoing trends in blood donor profiles. The creation and development of new mobile drive units and maintaining them over time was the key to increase the collection of blood units from voluntary, non-remunerated blood donors.

[Ophidian envenomation in the region Souss-Massa-Drâa in Morocco]. / Les envenimations ophidiennes dans la région de Souss-Massa-Drâa au Maroc.

The present study aims to determine the main characteristics of ophidian envenomation in the Souss-Massa-Drâa region in Morocco. It consisted of a descriptive retrospective analysis of all snakebite cases recorded by the Moroccan Poison Control and Pharmacovigilance Center, from 1980 to 2008. According to reported data, this region is the most affected in Morocco with 479 cases, that is 27.6% (17 cases/year). The average age of victims was 26.07 ± 18.28 years. The patients developed clinical signs (55%) dominated by disorders of the digestive system (35.5%), cardiovascular diseases (21.4%), and heart rhythm disorders (16.8%). The lethality and sequelae rates were 12% and 1.9%, respectively.

[Poisoning by Atractylis gummifera L. Morocco poison control center data]. / Intoxication par Atractylis gummifera L. Données du centre antipoison et de pharmacovigilance du Maroc.

To assess the extent and severity of poisoning by Atractylis gummifera L. in Morocco, a descriptive retrospective study was conducted on all the poisoning cases listed between 1981 and 2004 to the Morocco Poison Control Center. During this period, 240 people were hospitalized for glue thistle poisoning, 72% of which are children under 16 years. The severity of the poisoning has been affirmed by significant intrahospital lethality. Indeed, among the 182 patients for whom the outcomes were known, 98 died (54%).

[Epidemiology of snakebites in Morocco]. / Epidémiologie des envenimations ophidiennes au Maroc.

This study was based on a retrospective descriptive analysis of all cases of snakebite recorded at the Poison Control and Pharmacovigilance Center of Morocco from 1980 to 2008. A total of 1,761 snakebites, i.e., 61 cases per year, were observed during the study period. Males accounted for 54.5% of victims (sex ratio (M/F) = 1.2) and 70% of cases occurred in rural areas. The average age of snakebite victims was 26.7 +/- 17.5 years. A seasonal snakebite peak was observed between May and August coinciding with the warmest period of the year, harvest time and snake migration. Sixty-two percent of patients presented clinical symptoms including respiratory, cardiovascular, gastrointestinal, neurological and mucocutaneous signs. The average fatality rate was 7.2% per year and the sequel rate was up to 1.04%. This study demonstrates that management of snakebite is problematic in Morocco. Morbidity was probably underestimated. Restricted access to antivenom is a major problem in rural areas where the population cannot afford the cost.

Simultaneous determination of codeine and noscapine by flow-injection chemiluminescence method using N-PLS regression.

A flow injection chemiluminescent (FI-CL) method has been developed for the simultaneous determination of codeine and noscapine using N-PLS regression. The method is based on the fact that kinetic characteristics of codeine and noscapine are different in the Ru(phen)(3)(2+)-Ce(IV) CL system. In flow injection mode, codeine gives broad peak with the highest CL intensity at 4.4s, whereas the maximum CL intensity of the noscapine appears at about 2.6s. Moreover, the effect of increasing H(2)SO(4) concentration was different on the CL intensity of the compounds. An experimental design, central composite design (CCD), was used to realize the optimized variables such as Ru(II) and Ce(IV) concentrations for the both compounds. At the optimized condition, a three-way data structure (samples, H(2)SO(4) concentration, time) was constructed and followed by N-PLS regression. The number of factors for the N-PLS regression was selected based on the minimum values for the root mean squared error of cross validation (RMSECV). The proposed method is applied to the simultaneous quantification of codeine and noscapine in the pharmaceutical preparations.

Chemiluminescence determination of promazine in human serum and drug formulations using Ru(phen)3(2+)-Ce(IV) system and a chemometrical optimization approach.

A new chemiluminescence (CL) method using flow injection has been described for the rapid and sensitive determination of promazine hydrochloride (PMH). The method is based on the CL reaction of PMH with tris(1,10 phenanthroline)ruthenium(II), [Ru(phen)3(2+)] and Ce(IV) in sulfuric acid medium. Effects of chemical variables were investigated employing central composite design and response surface methodology. Under the optimum conditions, the CL intensity was proportional to the concentration of the drug in solution over the ranges 0.020-0.32 and 0.32-32 microg/mL. The limit of detection (signal-to-noise ratio = 3) was 0.012 microg/mL. The method was applied successfully to the determination of PMH in drug formulations and human serum (recovery percentages between 96.7 and 105.0%). The relative standard deviation for 11 replicate determinations of 1.5 microg/mL of PMH was 1.7%. The minimum sampling rate was 100 samples per hour.

Characterization of lactic acid bacteria isolated from the one humped camel milk produced in Morocco.

One hundred and twenty (120) strains of lactic acid bacteria (LAB) were enumerated and isolated from raw dromedary milk in Morocco using various cultured media. Strains isolated were characterized by phenotypic, physiological and biochemical properties. Results showed that high counts of LAB were found. Presumptive lactobacilli counts ranged from 2.5x10(2) to 6x10(7)cfu/ml, presumptive lactococci levels varied from 5x10(2) to 6x10(7)cfu/ml, presumptive streptococci counts varied from 4.2x10(2) to 8x10(7)cfu/ml, presumptive leuconostoc levels ranged from 5.4x10(2) to 5.4x10(7)cfu/ml. Results showed also that Lactobacillus and Lactococcus were the predominant genera with 37.5% and 25.8%, respectively. The dominated species found were Lactococcus lactis subsp. lactis (17.5%), Lactobacillus helveticus (10%), Streptococcus salivarius subsp. thermophilus (9.20%), Lactobacillus casei subsp. casei (5.80%) and Lactobacillus plantarum (5%). This is the first report on the characterization of LAB strains isolated from the one humped camel milk produced in Morocco.

Oral supplementation with vitamin C improves intestinal mucosa morphology in the pulmonary hypertensive broiler chicken.

1. The aim of this study was to determine the effects of added dietary vitamin C on the intestinal mucosa morphology in pulmonary hypertensive broiler chickens. 2. One-day-old chickens were reared at high altitude and treated with 400, 800 or 1200 mg vitamin C/l of drinking water for 48 d. Segments from the duodenum, jejunum and ileum were collected for morphometric analysis. 3. The duodenum and jejunum villus height, width, surface area and lamina propria thickness were greater in the highest vitamin C-treated groups compared to controls. 4. There were significant variations only in villus types of the jejunum and ileum: increased proportions of leaf + tongue-like villi and decreased proportions of convoluted + ridge-like villi at day 36 at the groups with 400 and 800 mg vitamin C/l. 5. It was concluded that vitamin C improves the gut morphology of the pulmonary hypertensive broiler chickens.

[Scorpion envenomation treated at Beni Mellal Provincial Hospital in Morocco]. / Les envenimations scorpioniques a l'hôpital provincial de Beni Mellal (Maroc).

The Beni Mellal province has one of the highest incidences of scorpion envenomation in Morocco. The purpose of this retrospective study was to report and analyze data recorded in scorpion envenomation victims admitted to the intensive care department of the Beni Mellal Provincial Hospital. A total of 63 patients were admitted in 2005. Most stings occurred during summer mainly in June and July. Most (60.3%) occurred at night between 6 p.m. and 6 a.m. Most patients were children younger than 16 years (mean, 10.2 +/- 12.9 years). At the time of admission, general manifestations of envenomation were present in 72.6% of patients and life-threatening symptoms were observed in 27.4%. Therapy consisted of symptomatic treatment and in-hospital mortality was 28.6%. There was not a significant difference in mortality in function of age or severity of manifestations at the time of admission.

Flow-injection chemiluminescence determination of enrofloxacin using the Ru(phen)3(2+)-Ce(IV) system and central composite design for the optimization of chemical variables.

The main purpose of this study was to develop an inexpensive, simple, rapid and sensitive chemiluminescence (CL) method for the determination of enrofloxacin (ENRO) using a flow-injection system. This method is based on rapid reduction of Ru(phen)(3)(3+), which is produced in the reaction between Ru(phen)(3)(2+) and acidic Ce(IV) by ENRO, producing strong CL. A central composite design (CCD) was used for optimization of the chemical variables. Regression analysis of the data from the CCD demonstrated that a second-order polynomial model is an adequate description of the surface over the factor limits studied. Optimization using CCD gave approximately four-fold better results than the single-factor-at-a-time method. Under optimal experimental conditions, the CL response was proportional to the concentration of ENRO over a wide range (0.008-3.6 microg/mL) with a correlation coefficient of 0.9986 and a detection limit of 0.003 microg/mL (3sigma). The relative standard deviation for 11 repeated determinations of 0.14 microg/mL ENRO was 4.2%. This method was successfully applied to the analysis of commercial formulations, spiked plasma and spiked poultry tissue. Sample analyses showed good recovery percentages for drugs and spiked plasma (95.1-103.9%). Recovery percentages for spiked poultry tissue were in the range 77.6-87.3%. The minimum sampling rate was 100 samples/h.

Sex, age and ABO blood groups in chemotherapy-induced oropharyngeal mucositis.

AIM: The contribution of host genetic factors in oropharyngeal mucositis is not fully understood. Therefore, we conducted this study to determine possible associations of age, sex, underlying disease, type of chemotherapy and ABO blood group antigens with the risk of chemotherapy-induced oropharyngeal mucositis. METHODS: A total of 641 patients (395 boys and 246 girls; mean age 6.82+/-4.08 years) treated by standard chemotherapy for different type of malignancies were enrolled in the study. Mucositis was scored using the WHO scale. RESULTS: Oropharyngeal mucositis was found in 65.4% of our population. Patients with hematological malignancies (RR=1.87; 95% CI 1.33-2.67; P<0.0001) and under antimetabolities drugs (RR=1.88; 95% CI 1.33-2.63; P<0.0001) were associated with increased risk of oropharyngeal mucositis. Also, patients with blood group O were at higher risk (RR=2.86; 95% CI 2.03-4.02; P<0.0001) compared to patients with blood type A (RR= 0.47; 95% CI 0.33-0.66; P<0.0001) and blood type B (RR=0.59; 95% CI 0.38-0.91; P= 0.01). No relationship was found between oropharyngeal mucositis and age or sex. CONCLUSIONS: To our knowledge this is the first report demonstrating an association between ABO blood group and oropharyngeal mucositis. Further investigations are needed for a better understanding of this relationship.

A simple and rapid flow injection chemiluminescence determination of cysteine with Ru(phen)3(2+)-Ce(IV) system.

A new chemiluminescence system was developed for the determination of cysteine by flow injection system. This method is based on the reaction of L-cysteine with Ru(phen)3(2+) and Ce(IV) to produce chemiluminescence. The calibration curve was linear over the range 8.0x10(-7) to 4.0x10(-5) and 4.0x10(-5) to 1.0x10(-3) M with a detection limit of 7.0x10(-7) M (S/N=3). The relative standard deviation of 4.0x10(-6) M cysteine was found 3.5% (n=10). The influence of potential interfering substances was studied. The proposed method was successfully applied for the flow injection determination of cysteine in the real samples with minimum sampling rate of 90 sample/h.

Factors affecting the size of ovulatory follicles and conception rate in high-yielding dairy cows.

Two studies were designed to determine (1) the effects of Heatsynch and Ovsynch protocols versus spontaneous ovulation and (2) the effects of calving problems, clinical uterine infections, and clinical mastitis on the size of the ovulatory follicle, conception rate, and embryonic/fetal (E/F) death in high-yielding dairy cows. In study 1, cows without the history of calving problems, clinical uterine infections, and clinical mastitis were randomly allocated to either an Ovsynch (n = 45) or Heatsynch (n = 39) ovulation synchronization protocol or spontaneous ovulation (n = 43) groups. Blood samples were collected on the day of artificial insemination (AI) to measure progesterone (P4), estradiol-17ß, and insulin-like growth factor 1 (IGF-1) and 7 days later to measure P4. Study 2 consisted of cows (n = 351) with or without the history of calving problems, clinical uterine infections, and clinical mastitis which were artificially inseminated after a 55-day voluntary waiting period. Transrectal ultrasonography was performed at the time of AI to measure the ovulatory follicle size and on Days 30 and 68 after AI to diagnose pregnancy in both studies. In study 1, the mean (±standard error of the mean) diameter of the ovulatory follicle was greater (P = 0.0005) and E/F mortality was lower (P = 0.007) for the spontaneous ovulation group compared with Ovsynch and Heatsynch groups. Serum concentration of P4 on Day 7 after AI was correlated with the size of the ovulatory follicle (P = 0.007). Conception rate at Days 30 and 68 was not significantly different between the three experimental groups in study 1. Cows with serum IGF-1 concentrations greater than 55 ng/mL at AI had significantly higher Day 68 conception rate (50% vs. 24%) and lower E/F death (16.6% vs. 40%) compared to cows with serum IGF-1 concentrations lower than 56 ng/mL at AI. The conception rate on Days 30 and 68 for follicles of 10 to 14 mm in diameter (34% and 21.8%) was significantly lower than follicles of 14.1 to 19 mm in diameter (60% and 50%), respectively (P < 0.05). In study 2, the ovulatory follicle in cows with clinical uterine infections was smaller than that in cows without clinical uterine infections (16.4 vs. 17.1 mm; P = 0.04). In conclusion, the size of the ovulatory follicle is affected by ovulation synchronizing protocols and postpartum clinical uterine infections. In addition, cows with higher serum IGF-1 concentrations on the day of AI had higher Day 68 conception rate and lower E/F death.

[Scorpion poisonous stings in the population of Khouribga (Morocco)]. / Les piqûres et les envenimations scorpioniques au niveau de la population de Khouribga (Maroc).

Poisonous stings caused by scorpion constitute a public health problem in Morocco because of their frequency severity and socio-economic consequences that they generate. The province of Khouribga surveyed for this study is situated in a zone of high incidence and high lethality caused by scorpion stings in Morocco. In order to analyze the epidemiological profile and the poisoning risk factors, we are presenting the results of a past study conducted from April to December 2001. It consisted in making an exhaustive follow up from admission to release of all patients stung by scorpion. These patients consulted a sanitary structure (dispensary health centre or hospital) in the province of Khouribga, Morocco. Within a total of 1212 cases of stings, 63% of them occurred at night (between 06 pm and 06 am) particularly during July and August. Youngsters under fifteen represented 36% of these cases. 3.4% of the people who got stung presented typical poisoning and envenomation. The delay expected from sting to transfer to a medical structure was 1.85 +/- 0.11 hours for the patients who recovered against 2.67 +/- 0.11 for those who did not recover. To be noticed as well that 1.3% of the subjects who got stung die. Variance analysis indicates that the type of sanitary structures receiving patients, admission classes, and age of patients influence significantly the recovery rate of people who are stung.