[Infective endocarditis in Morocco through the experience of a hospital department]. / L'endocardite infectieuse au Maroc à travers l'expérience d'un service hospitalier.

Infective endocarditis is a grave disease because of a high level of morbidity and mortality. We conducted a retrospective analysis of 100 patients hospitalized for infective endocarditis from January 2009 until December 2015. The mean age was 41 years with a male predominance. Infective endocarditis occurs on a native valve (77 patients), prosthetic valves (12 patients), Pacemaker (7 patients) and congenital heart disease (4 patients). The diagnostic delay was 77 days on average. The fever was present in 85 patients. Blood cultures were negative in 54 patients. Echocardiography allowed visualizing the vegetations in 95 patients. In patients with prosthetics valves, a paraprosthetic regurgitation was diagnosed in 54 % of these patients and vegetation in 18 %. The main complications are heart failure (42), neurological (19), spleen (10) and renal (23) complications. The evolution under medical treatment was marked by the clinical-laboratory improvement in 57 patients, the lack of improvement with persistent fever in 21 patients. The mortality rate of our series is 23 %. Only seven patients underwent urgent surgery for hemodynamic and infectious indications. At the end of this work, it is emphasized that the epidemiological profile of infective endocarditis does not follow the changes of Wold. Its management is difficult in our context (significant diagnostic delay, often negative blood cultures, high level of morbidity, lack of recourse to early surgery). The improvement of this disease consistes of the prevention of acute articular rhumatism and the establishment of an heart team endocarditis to adapt international recommendations to our context.

[Management of multiple valve disease]. / Prise en charge de la maladie polyvalvulaire.

Polyvalvular disease is not a rare condition, the lack of specific data for each situation does not allow perfoming standardized management and guidelines. We want to present by this review available data on the management of polyvalvular disease, taking into account different possible associations between the valve lesions.

[Convulsives crisis revealing left-ventricular non-compaction with apical myocardial infarction]. / Crises convulsives révélant une non-compaction du VG compliquée d'un IDM apical.

Left-ventricular non-compaction is a rare congenital disorder and its association with myocardial infarction is rarely described in literature. We report the case of a patient in whom the diagnosis was established after multiple convulsive crisis. The resemblance of certain consequences of these two pathologies reports the difficulty of the diagnosis of imputability and all the specificity of this observation.

[Segmental renal hypoplasia or Ask-Upmark kidney -- anatomopathologic approach: report of 2 cases]. / Hypoplasie rénale segmentaire ou rein d'Ask-Upmark--approche anatomoclinique: à propos de 2 observations.

Segmental renal hypoplasia or Ask-Upmark kidney is an extremely rare anomaly that induces severe arterial hypertension in young patients. Two new cases of this entity are presented respectively in a 39 and 31 years old women who are admitted for hematuria, elevated blood pressure level and flank pain. Surgical treatment of the hypoplasia kidney permitted successful treatment of the high blood pressure with preservation of renal function and flank pain. In view of the literature, the authors discuss the pathogenic, diagnostic and therapeutic aspects of this condition.

[Vascular complications of infective endocarditis: a retrospective analysis of 18 cases]. / Les complications vasculaires de l'endocardite infectieuse.

OBJECTIVES: Among 82 patients hospitalized for infective endocarditis between June 1995 and June 2001 at the cardiology B unit of the Rabat University Hospital Morocco, 18 (22%) had one or more vascular complications. We present here a retrospective analysis. PATIENTS AND METHODS: The cohort included 12 men and 6 women, mean age 22 years. Infective endocarditis had grafted on a pre-existing cardiopathy among 17 patients: rheumatic heart disease (n=14), mechanical prosthetic valve (n=2), congenital heart disease (n=1). RESULTS: For 12 patients, vascular disease was the only complication, 1 had two complications and 4 three complications. This gave 26 lesions: 11 neurological complications, 10 arterial diseases involving the limbs including 5 mycotic aneurysms, 2 acute myocardial infarcts, 2 splenic infarcts, and 1 recurrent septic pulmonary embolism. Vascular disease was the inaugural manifestation in 9 patients and 54% of the complications occurred before the end of the second week of antibiotic treatment. Blood cultures were positive in 7 patients (40%). Oral streptococcus was isolated in 5 cases, Gram-negative bacillus in 1 case and Staphylococcus aureus in 1. Echography revealed valvular vegetations in the 16 cases of infective endocarditis on native valves: mitral (n=9), aortic (n=5), mitroaortic (n=1), tricuspid (n=1). Short term outcome was marked by 4 deaths including 3 directly related to the vascular complication. DISCUSSION: We emphasize the variable and diverse features of vascular complications of infective endocarditis. Prevention and early diagnosis are essential to institute optimal management of infective endocarditis.

Preparation of lyophilized and liquid intravenous immunoglobulin G: development and scale-up.

BACKGROUND AND OBJECTIVES: Intravenous immunoglobulin G (IVIG) preparations are used in several disorders: primary and secondary immunodeficiencies, autoimmune and systemic inflammatory diseases, and in infectious diseases as effective therapy. In this work, we report a method of processing IVIG (lyophilized and liquid) from Cohn fraction II (FII) paste. MATERIALS AND METHODS: The process included the following steps: virus inactivation by heat in a solution of FII, ultrafiltration, treatment at pH 4 with traces of pepsin, diafiltration and final formulation. Optimizations for each step on a small scale are described. The method has been effectively scaled-up. RESULTS: The final product contained at least 99% monomers plus dimers of IgG, a low anti-complementary activity (AcA) < 1 CH50/mg, and the remaining quality parameters fell within the range fixed by the European Pharmacopoeia. CONCLUSION: The method described is an effective way of preparing large quantities of IVIG (lyophilized and liquid) which fulfils the standard requirements of both the European Pharmacopoeia and the World Health Organization.

[Heart involvement in carcinoid syndrome: report of a case]. / Atteinte cardiaque au cours du syndrome carcinoïde: à propos d'un cas.

The authors report the case of tricuspid and pulmonary disease, revealing a carcinoid syndrome in a 32 years-old young man who was admitted for asthenia and an effort hepatology. The carcinoid syndrome was confirmed by hormonal proportioning, and by an anatomopathologic and immunohistochimic study of a hepatic metastatic biopsy. The check-up to search the primitive tumor was negative. The clinicals, paraclinicals and therapeutics aspects of the carcinoid heart were reported in this work.

[Arterial thrombosis in the course of nephrotic syndrome. Report of three cases]. / Les thromboses artérielles au cours du syndrome néphrotique. A propos de trois observations.

Vascular thrombosis remains severe complication in patients with nephrotic syndrome. Both venous and arterial thrombosis are observed. We report three new cases of arterial thrombosis in patients with nephrotic syndrome. The role of acquired hemostasis disorders, inducing hypercoagulability, is predominant. Extramembranous glomerulonephritis remains the most frequent cause of nephrotic syndrome, complicated by vascular thrombosis. Treatment is based on anticoagulation and corticosteroid therapy. Search for proteinuria should be part of the etiology work-up in all patients with vascular thrombosis of undetermined origin.

Isolation and partial characterization of N-acetyl-D-galactosamine-binding lectins from Epiphragmophora trenquelleonis snail.

A human blood type A hemagglutinating activity was detected in albumin gland extracts of Epiphragmophora trenquelleonis snail separated by GalNAc-agarose affinity chromatography, of which two N-acetyl-D-galactosamine-binding lectins in the extracts were ETL1 was displaced from the affinity column with 1 mM GalNAc, and ETL2 with 20 mM GalNAc. Both lectins agglutinated specifically human blood type A and AB erythrocytes, but not type B and O erythrocytes. Gel filtration chromatography gave a native molecular weight of about 59 kDa for ETL1 and about 54 kDa for ETL2. On SDS-PAGE under nonreducing conditions, ETL1 showed two protein subunits of about 29 and 27 kDa, while ETL2 showed three protein subunits of about 27, 24, and 22 kDa. On SDS-PAGE under reducing conditions, both lectins showed four protein subunits of 17, 16, 12, and 11 kDa. By Western blot analyses developed with biotin-labeled lectins, N-linked oligosaccharides were detected in the 17- and 16-kDa protein subunits of ETL1 and ETL2, and in the 12-kDa protein subunit of ETL2. O-linked oligosaccharides were detected only in the 11-kDa protein subunit of ETL1 and ETL2. On isoelectric focusing both lectins exhibited microheterogeneity: ETL1 focused as three protein bands with pIs in the range of 5.6-6.0, while ETL2 focused as four protein bands with pIs in the range of 6.8-7.4. We suggest that native ETL1 and ETL2 are glycoprotein complexes with molecular weights of 59-54 kDa, composed of two 29-22-kDa nonreduced protein subunits held together by noncovalent hydrophobic interactions. Each of the nonreduced protein subunits seems to be composed of two 17-11-kDa reduced protein subunits held together by interchain disulfide linkages. The main differences between ETL1 and ETL2 could be due to different posttranslational modifications or to the relative contribution of one or more of their protein subunits.

Serum pregnancy-associated alpha 2-glycoprotein levels in the evolution of hepatitis B virus infection.

Serum pregnancy-associated alpha 2-glycoprotein (alpha 2-PAG) levels were evaluated in a follow-up study of patients with hepatitis B virus (HBV) infection and compared with biochemical and virological parameters. In a study of 25 patients with acute hepatitis, an association was found between high alpha 2-PAG values, ALT levels, and HBsAg in 20 patients (80%) (P less than 0.05), 18 recovered completely, and 2 had a protracted course. In five patients serum alpha 2-PAG levels were similar to those in the control group. On the other hand, eight (100%) chronic persistent HBV patients showed high levels of alpha 2-PAG (P less than 0.05) during the study period, and these levels correlated well with inflammatory activity and failure of HBsAg elimination. There were no significant differences in alpha 2-PAG values between asymptomatic HBsAg carriers and controls. Serial analysis of alpha 2-PAG, in correlation with viral markers, biochemical parameters, and histological data, would contribute to the ability to predict the final outcome of HBV infection.

Serologic study by competitive enzyme-linked immunosorbent assay of pregnancy-associated alpha 2-glycoprotein in hepatitis B virus infection.

Serum levels of pregnancy-associated alpha 2-glycoprotein (alpha 2-PAG) in patients with hepatitis B virus (HBV) infection were compared with those of healthy male subjects used as controls by a competitive enzyme-linked immunosorbent assay (ELISA). Assay parameters were optimized, and minimal detectable concentration was 100 ng/ml. The alpha 2-PAG levels in 22/26 acute HBV patients showed a very significant statistical difference when compared with controls (x2 = 19.93, p less than 0.0005). On the other hand, 8/8 chronic persistent HBV patients showed high levels with a range between 51 to 200 ug/ml (x2 = 18.16, p less than 0.0005). There was no significant difference between asymptomatic HBsAg carriers and controls. Although alpha 2-PAG apparently exhibits immunosuppressive properties similar to other factors present in HBV infection, follow-up studies are needed to elucidate its role in the natural evolution of this disease.