Lynch syndrome or hereditary non polyposis colorectal cancer (HNPCC) in a moroccan family: Case report.

INTRODUCTION AND IMPORTANCE: Colorectal cancer is a major global health problem. In 5% of cases, a genetic predisposition to cancer's syndrome is the etiology, such as Lynch syndrome. The population prevalence of Lynch syndrome has been estimated at 1/440. The objectives of this study are to show the interest of the oncogenetic consultation in the management of patients with suspicion of Lynch syndrome. CASE PRESENTATION: It is a 70-year-old patient with a family history of different neoplasms. The patient has also been followed for an adenocarcinoma of the colon. An oncogenetic consultation was indicated, which led to the diagnosis of Lynch syndrome, according to the Amsterdam II criteria. A study of the MisMatch Repair genes was requested, to allow a pre-symptomatic diagnosis of apparented subjects at risk, and thus to also allow monitoring and early diagnosis of neoplasms or prophylactic measures. DISCUSSION: Lynch syndrome is one of the most common cancer susceptibility syndromes. A constitutional deleterious mutation in one of the DNA MisMatch Repair genes, is responsible for nearly 70% of cases of this syndrome. The oncogenetic consultation and the identification of the genetics cause, makes it possible to set up specific monitoring and to offer a pre-symptomatic test to all major relatives of the index case. CONCLUSION: This medical observation shows the benefit of the oncogenetic consultation, if a genetic predisposition to cancer's syndrome is suspected. The diagnostic of this predisposition and monitoring of the propositus and his exposed, like in Lynch syndrome will help in the early management of cancers, specially colorectal cancer and endometrial adenocarcinoma.

Implications of crop model ensemble size and composition for estimates of adaptation effects and agreement of recommendations.

Climate change is expected to severely affect cropping systems and food production in many parts of the world unless local adaptation can ameliorate these impacts. Ensembles of crop simulation models can be useful tools for assessing if proposed adaptation options are capable of achieving target yields, whilst also quantifying the share of uncertainty in the simulated crop impact resulting from the crop models themselves. Although some studies have analysed the influence of ensemble size on model outcomes, the effect of ensemble composition has not yet been properly appraised. Moreover, results and derived recommendations typically rely on averaged ensemble simulation results without accounting sufficiently for the spread of model outcomes. Therefore, we developed an Ensemble Outcome Agreement (EOA) index, which analyses the effect of changes in composition and size of a multi-model ensemble (MME) to evaluate the level of agreement between MME outcomes with respect to a given hypothesis (e.g. that adaptation measures result in positive crop responses). We analysed the recommendations of a previous study performed with an ensemble of 17 crop models and testing 54 adaptation options for rainfed winter wheat (Triticum aestivum L.) at Lleida (NE Spain) under perturbed conditions of temperature, precipitation and atmospheric CO2 concentration. Our results confirmed that most adaptations recommended in the previous study have a positive effect. However, we also showed that some options did not remain recommendable in specific conditions if different ensembles were considered. Using EOA, we were able to identify the adaptation options for which there is high confidence in their effectiveness at enhancing yields, even under severe climate perturbations. These include substituting spring wheat for winter wheat combined with earlier sowing dates and standard or longer duration cultivars, or introducing supplementary irrigation, the latter increasing EOA values in all cases. There is low confidence in recovering yields to baseline levels, although this target could be attained for some adaptation options under moderate climate perturbations. Recommendations derived from such robust results may provide crucial information for stakeholders seeking to implement adaptation measures.

Association of vitamin D status with multiple sclerosis in a case-control study from Morocco.

BACKGROUND: Growing evidence suggests that hypovitaminosis D contributes to the pathogenesis of multiple sclerosis (MS). OBJECTIVE: This study aimed to evaluate whether vitamin D levels are associated with having MS and some of its characteristics in the Moroccan population. METHODS: Using liquid chromatography-tandem mass spectrometry, the 25(OH)D3 metabolite was measured to quantify vitamin D serum levels (DSLs) in 113 patients with MS and 146 healthy controls matched for gender and age. DSLs were then compared between patients and controls, with correlations sought between DSLs and gender, age at onset, disease duration, MS type, degree of disability (EDSS score) and disease severity (MSSS) in patients. RESULTS: Hypovitaminosis D (DSL<30ng/mL) was observed in 97.3% of MS patients and in 98.6% of controls. Although the mean DSL was slightly lower in patients (11.69±6.97ng/mL) than in controls (12.98±6.58ng/mL), there was no significant association between DSL and MS status (P=0.131). Similarly, among patients, no apparent association was found between DSL and MS type (P=0.214), EDSS score (P=0.076) or MSSS (P=0.772). CONCLUSION: Our study suggests that DSL is not associated with having MS nor with MS type, degree of disability or disease severity in the Moroccan population. On the other hand, DSL was lower in women and decreased with age.

[The red eye]. / L'oeil rouge.

The red eye is a frequent symptom in emergency consultation. The general practitioner should be aware about the sample of possible etiologies. The diseases causing redness are various, sometimes benign but sometimes threatening vision. The most frequent diagnostic hypotheses will be summarized here, as well as the practical methodological elements allowing gross differential diagnosis in the absence of specific instrumentation.

Factors influencing women's willingness to volunteer in the healthcare system: evidence from the Islamic Republic of Iran.

This case-control study evaluated the factors influencing volunteering in the Islamic Republic of Iran's Women's Health Volunteer (WHV) programme, which is implemented in 150 centres in Khorasan-e-Razavi Province. We recruited 145 cases (volunteers) and 146 controls (non-volunteers) from the centres. Data were collected by questionnaire. Sociodemographic variables included were: length of residence in neighbourhood, number of siblings, husband's age and education and job, family size, quality of life, self-rated health status, neighbourhood intimacy, child under 2 years, house ownership, wealth index. Social network variables included were: ego network size, type of acquaintance, intimacy with others, relationship communication, relationship duration, emotional support, advisory support, monetary support, physical support, time support. There were significant associations (P<0.05) between women's propensity to volunteer and family size, presence of a child under 2 years in the family, neighbourhood intimacy, social network composition, and emotional and advisory support.

Factors influencing women's willingness to volunteer in the healthcare system: evidence from the Islamic Republic of Iran

This case-control study evaluated the factors influencing volunteering in the Islamic Republic of Iran's Women's Health Volunteer [WHV] programme/which is implemented in 150 centres in Khorasan-e-Razavi Province. We recruited 145 cases [volunteers] and 146 controls [non-volunteers] from the centres. Data were collected by questionnaire. Sociodemographic variables included were: length of residence in neighbourhood, number of siblings, husband's age and education and job, family size, quality of life, self-rated health status, neighbourhood intimacy, child under 2 years, house ownership, wealth index. Social network variables included were: ego network size, type of acquaintance, intimacy with others, relationship communication, relationship duration, emotional support, advisory support, monetary support, physical support, time support. There were significant associations [P < 0.05] between women's propensity to volunteer and family size, presence of a child under 2 years in the family, neighbourhood Intimacy, social network composition, and emotional and advisory support

Patterns of genetic diversity and population structure of the threatened Houbara and Macqueen's bustards as revealed by microsatellite markers.

The Houbara bustard (Chlamydotis undulata) is a threatened avian species that is rapidly declining throughout its range, especially in North Africa, Asia and the Canary Islands. We examined the population structure and genetic variation for the three Houbara subspecies C. undulata undulata, C. u. fuertaventurae and C. u. macqueenii. A total of 266 birds from 10 populations were genotyped using seven polymorphic microsatellite markers. The analysis of microsatellite loci generated 1821 genotypes and 55 different alleles. Estimates of observed and expected heterozygosities were relatively high and ranged from 0.371 to 0.687 and from 0.326 to 0.729, respectively. For the first time, significant phylogeographic structure among Asian Houbara populations was found using neutral nuclear markers. Analysis of molecular variance revealed 12.03% population variability among the subspecies. Population structure and assignment tests inferred using a Bayesian approach revealed two distinct clusters with more than 90% likelihood, one Asian and one North African. A positive correlation between genetic distance and geographic distance was detected among populations (r(2) = 0.302). For conservation purposes, this genetic information will help understand the current genetic status improving management strategies for Houbara bustard breeds and populations.

Propofol 2 mg/kg is superior to propofol 1 mg/kg for tracheal intubation in children during sevoflurane induction.

BACKGROUND: Propofol has been used to facilitate tracheal intubation within a short time of sevoflurane induction without a muscle relaxant in children. We compared as the primary outcome the incidence of excellent intubating conditions after 8% sevoflurane and propofol 1 or 2 mg/kg. METHODS: One hundred and four patients (2-7 years) were randomly assigned to receive propofol 1 mg/kg in group SP1 (n=53) or propofol 2 mg/kg in group SP2 (n=51) after inhalation induction using sevoflurane 8% in oxygen. Forty-five seconds after propofol and controlled ventilation, intubating conditions were assessed using a four-point scoring system based on ease of laryngoscopy, vocal cords position, coughing, jaw relaxation and limb movement. Heart rate and systolic blood pressure were measured as baseline, after sevoflurane induction, propofol, intubation and at 2 and 5 min following intubation. RESULTS: Three patients in group SP1 were excluded from analysis. Time from sevoflurane induction to intubation (248.9±71.3 s in group SP1 vs. 230.9±61.3 s in group SP2) and endtidal sevoflurane before intubation (5.6±1.6% in group SP1 vs. 5.2±1.5% in group SP2) did not differ between the two groups. The incidence of excellent intubating conditions was significantly higher in group SP2 compared with group SP1 [47/51 (92%) vs. 28/50 (56%)]. The incidence of acceptable intubating conditions was significantly higher in group SP2 compared with group SP1 [48/51 (94%) vs. 35/50 (70%)]. No hemodynamic difference was noted at any time point between the two groups. CONCLUSION: Propofol 2 mg/kg during 8% sevoflurane induction resulted in a higher proportion of excellent intubating conditions compared with propofol 1 mg/kg.

[Malignant degeneration of benign cystic teratoma of the ovary]. / Tératome cancérisé de l'ovaire.

Malignant transformation of mature cystic teratoma of the ovary is a rare complication occurring preferentially during peri- and post-menopausal period. No clinical nor radiological, nor biological signs are specific to malignant transformation. The treatment is surgical and similar to that of epithelial tumors of the ovary. We report an observation of a squamous cell carcinoma developed on a mature cystic teratoma of the ovary, in a patient aged 46 years.

Tracheal intubation following training with the GlideScope compared to direct laryngoscopy.

SUMMARY: Tracheal intubation using direct laryngoscopy has a high failure rate when performed by untrained medical personnel. This study compares tracheal intubation following direct laryngoscopy by inexperienced medical students when initially trained by using either the GlideScope, a video assisted laryngoscope, or a rigid (Macintosh) laryngoscope. Forty-two medical students with no previous experience in tracheal intubation were randomly divided into two equal groups to receive training with the GlideScope or with direct laryngoscopy. Subsequently, each medical student performed three consecutive intubations on patients with normal airways that were observed by a anaesthetist who was blinded to the training method. The rates of successful intubation were significantly higher in the Glidescope group after the first (48%), second (62%), and third (81%) intubations compared with the Macintosh group (14%, 14% and 33%; p = 0.043, 0.004 and 0.004, respectively). The mean (SD) times for the first, second, and third successful tracheal intubations were significantly shorter in the Glidescope group (59.3 (4.4) s, 56.6 (7.1) s and 50.1 (4.0) s) than the Macintosh group (70.7 (7.5) s, 73.7 (7.3) s and 67.6 (2.0) s; p = 0.006, 0.003 and 0.0001, respectively). Training with a video-assisted device such as the GlideScope improves the success rate and time for tracheal intubation in patients with normal airways when this is performed by inexperienced individuals following a short training programme.

[Relationship of white matter lesions on brain computed tomography and cognitive function in elderly subjects with mild cognitive impairment]. / Relations entre troubles cognitifs et lésions de la substance blanche cérébrale.

UNLABELLED: White matter lesions (WML) are frequently disclosed on elderly people computed tomography (CT) brain scan. OBJECTIVE: To evaluate the relationship between WML and cognitive functions of patients suffering from Mild Cognitive Impairment (MCI). METHODS: We studied the association between WML on CT brain scan and cognitive functions in 136 consecutive elderly subjects attending a geriatric outpatient clinic, suffering from MCI. The global cognitive assessment was based on Mini Mental State Examination (MMSE), a validated comprehensive battery of neuropsychological tests, the Cognitive Efficiency Profile (CEP), a CT brain scan and a complete biological screening. WML on CT brain scan was evaluated by a blinded investigator. RESULTS: In this population, 75 +/- 8 years of age, (women 60%, and hypertension 54%), 33% of subjects had WML on CT brain scan. Patients with WML were significantly older (OR=1.27; IC 95%=1.04 - 1.22), had more frequently a past history of hypertension (OR=2.71; IC 95%=1.06 - 6.96) and more frequently lacunae associated with WML (OR=4.48; IC 95%=1.18 - 16.99). Subjects with WML had significantly poorer cognitive functions than those without WML (CEP score/100=62.33 +/- 13.58 versus 71.87 +/- 14.19, p<0.01 and MMSE score/30=27.02 +/- 2.34 versus 27.97 +/- 1.89, p<0.01) CONCLUSION: Our results showed a relationship between WML on CT brain scan and the depth of cognitive dysfunction among MCI patients. Further long term prospective studies have to be performed to determinate if WML are involved in transitions between MCI and Alzheimer' s disease.

Removal of methylene blue from aqueous solution by fibrous clay minerals.

Kinetics and equilibrium processes of the methylene blue (MB) retention from aqueous solution by a mixture of fibrous clay minerals, which was isolated from a naturally occurring clay, were investigated. For these purposes, the effects of contact time, initial adsorbate concentration, adsorbent content, pH and ionic strength were determined. The results show that the MB retention obeys a pseudo-first order equation and the process is a diffusion controlled solid-state reaction. Moreover, the isotherm data fitted the Langmuir equation and the MB binding process became more energetic with the increase of the adsorbent concentration. In addition, the augmentation of the clay content or the initial MB concentration reduced the adsorption capacity, presumably because of the clay particles microaggregation and/or the occurrence of MB deriving species. On the other hand, it is observed that the MB uptake limit is reduced in low acid pH, particularly below the PZC, as well as in ionic strengthen solutions. These facts are linked to the silanol group protonation and to the reduction of the electrostatic forces induced by the clay particles, respectively.

Stability study of lipoic acid in the presence of vitamins A and E in o/w emulsions for cosmetic application.

The effectiveness of any cosmetic product containing a functional ingredient is determined by the skin delivery of the active molecule, which is influenced by the type of carrier and the molecule itself. Furthermore, the functional ingredient should be stable in the formulation. The purpose of this paper is to study the stability of lipoic acid in the presence of vitamins A (as palmitate) and E (as acetate) in semisolids for cosmetic use. The systems formulated were studied in regard to their aspect, pH, stability under centrifugation, and rheological behavior. The chemical analyses of lipoic acid and vitamins A and E were carried out by HPLC after studying the specificity of the method employed in each case. The quantitation of the active principles was performed by HPLC with C18 (5 microm) columns. The mobile phase was methanol for the vitamins, with spectrophotometric detection at 325 nm for vitamin A and 230 nm for vitamin E. The mobile phase for lipoic acid was methanol:water (80:20) and phosphoric acid at pH 3.0, with spectrophotometric detection at 332 nm. All systems were stable to centrifugation, and no significant modification of rheological behavior was observed in relation to the base emulsion used as control. The chemical studies performed indicated that although lipoic acid is not very stable in these formulations, the presence of vitamin A favors its chemical stability.

[Right atrial rupture following a hoof kick to the chest wall]. / Rupture de l'auricule droit après traumatisme thoracique fermé secondaire à un coup de sabot.

Several myocardial lesions can be induced by thoracic blunt trauma. It varies from myocardial lesions to heart rupture. We report a case of right atrial rupture due to unusual blunt trauma: a hoof kick. We describe a successful management of this case. We suggest that a diagnosis of cardiac chamber rupture should be considered in all cases of blunt thoracic trauma.

Right atrial rupture following a hoof kick to the chest wall.

We report a case of right atrial rupture due to blunt trauma by a hoof kick to the anterior chest wall. We describe our successful management of this case. We suggest that a diagnosis of cardiac chamber rupture should be considered in all cases of blunt thoracic trauma.

[Spinal ischemia after biiliac aneurysm surgery related to Behçet's disease diagnosed two years later]. / Ischémie médullaire après chirurgie d'un anévrysme bi-iliaque rattaché 2 ans plus tard à une maladie de Behçet.

A 26-year-old woman underwent bypass surgery for biiliac aneurysm of unknown origin. The aorta was cross clamped below the renal arteries to insert a tube graft between the infra-renal aorta and the external iliac arteries with implantation of the internal iliac arteries on the prosthesis. Due to leakage from the posterior area of the proximal anastomosis, the proximal suture was redone. Total cross clamping lasted 65 minutes. No blood pressure drop was noted during or after the procedure. Postoperatively, the neurological examination revealed paraplegia with mild sensorial deficit and fecal and urinary incontinence. The fecal and urinary deficit resolved three months later. Nearly complete motor recovery was noted at the 18(th) postoperative month. The patient then presented oral and genital ulceration at 22 months postop leading to the diagnosis of Behçet's disease. Several risk factors have been suggested to explain spinal ischemia after abnormal aortic surgery: anatomic variablility of spinal perfusion, duration of aortic cross clamping, and intra- or postoperative episodes of hypotension. Thrombotic damage to the arterial system due to Behçet's disease could also perturb spinal blood supply and reproduce one of the mechanisms incriminated in ischemic spinal lesions occurring during aortic surgery for atheromatous aneurysm.

[Behçet's disease revealed by bilateral femoral aneurysm]. / Maladie de Behçet révélée par un anévrysme fémoral bilatéral.

Behçet's disease is a chronic vascularitis characterized by recurrent ulcers of the mouth and genitalia and iridocyclitis. Vascular complications involving venous thrombosis and arterial lesions are rare. We report a case of Behçet's disease in 30 year-old man revealed by a voluminous right femoral aneurysm and a thrombosed aneurysm of the left iliofemoral trunk. Disease exacerbation was marked by oral ulceration and ocular lesions that delayed surgical cure for 7 days. After surgical resection of the aneurysm, a femoro-femoral bypass was constructed with a polytetrafluoroethylene graft. The left iliofemoral aneurysm was left intact. After 4 years of regular follow-up, there have been no surgical complications. The timing of surgery in patients with a voluminous aneurysm is debated during phases of active disease.

Synthesis of biheterocyclic alpha-amino acids.

We report here the synthesis of biheterocyclic alpha-amino acids by 1,3 dipolar cycloaddition of acetylenic compounds on alpha-azido alpha-amino esters.