[Miliary tuberculosis]. / La miliaire tuberculeuse,une série rétrospective marocaine.

INTRODUCTION: Tuberculosis miliary is a severe and rare form of tuberculosis. It is often due to a haematogenous spread of the bacillus of Koch and represents less than 2 % of tuberculosis. PATIENTS AND METHODS: We conducted a retrospective study of 81 cases of tuberculous miliary collected at the Department of respiratory diseases of the Ibn Rochd university hospital in Casablanca between September 2003 and November 2016. RESULTS: A female predominance was noted with 58 % of the cases. The average age was 36 years. The history of tuberculosis was found in eight cases and tuberculous tuberculosis in eleven cases, postpartum in five cases, diabetes in three cases and trisomy 21 in one case. The clinical picture was dominated by altered general status in all cases, and fever in 69 cases (86 %). Chest x-ray showed a miliary aspect in all cases, cardiomegaly in two cases, pyopneumothorax in three cases, and opacities excavated in five other cases. The intradermal tuberculin reaction, performed in all cases, was positive in 26 cases, and sputum oscillations were positive in 21 cases. The dissemination report found cerebromeningeal involvement in nine cases, with cerebral tuberculomas in five cases, pericarditis in four cases, mediastinal and peripheral adenopathies in nine cases each. Bouchut tubercles were found in nine cases. Antibacillary therapy was started as a matter of urgency, according to the national TB control program with the old regimen (2SHRZ/7RH) and the new regimen (2RHZEb/7RH) in all cases. The outcome was good in 55 cases (68.9 %), 17 patients were lost to follow-up, and 11 deaths were reported. CONCLUSION: We insist on this work on the severity of the tuberculous miliary and the need for early and urgent therapeutic management.

[Tuberculosis of the lung bases]. / La tuberculose des bases pulmonaires.

INTRODUCTION: Tuberculosis is a major public health problem in Morocco. Tuberculosis of the lung bases is a rare and atypical form and raises real diagnostic problems. PATIENTS AND METHODS: We report a retrospective study of 21 cases of basal pulmonary tuberculosis, collected at the service of respiratory diseases in Ibn Rushd hospital in Casablanca between 2004 and 2015 (11 years). RESULTS: From a total of 21 patients having basal pulmonary tuberculosis, 13 (62%) were women versus eight men (48%), the average age was 33 years. The average time of diagnosis was 25 days. The disease was unilateral in 20 cases (95%). The right lower lobe was the most frequently affected (71%). Inhomogeneous opacities (66%) and consolidation (28%) were the main radiological findings. Associated comorbidities were dominated by diabetes in six cases (28%). Bronchoscopy had recovered thickening spurs in eight cases, endobronchial granules in seven cases and bronchial inflammation in six cases. Bronchial biopsies had found a necrotizing granulomatous inflammation tuberculoide in seven cases (33%). The smear was positive in sputum in three cases (14%), in the bronchial aspirate in four cases (19%), in induced sputum in one case (4.7%) and in post-bronchoscopic sputum in six cases (28%). The antituberculous treatment was started in all patients with good clinical and radiological evolution. CONCLUSION: The basal localization of the pulmonary tuberculosis is misleading; source of diagnostic delay, hence the need to think about it especially in patients with comorbidities.

[Treatment of the first episode of spontaneous pneumothorax]. / Prise en charge du premier épisode de pneumothorax spontané.

INTRODUCTION: The management of a first episode of spontaneous pneumothorax is controversial and the best technique to be used as an initial intervention, aspiration or intercostal drainage, is still debated. PATIENTS AND METHODS: We present a retrospective case series during two and a half consecutive years describing the immediate management of spontaneous pneumothoraces, comparing aspiration versus thoracic drainage. RESULTS: One hundred and thirty-three clinical files from patients with spontaneous pneumothoraces were analyzed (17 primary and 116 secondary). The pneumothoraces were of varying size and different etiologies. Patients were initially treated with simple aspiration in 68 cases, with an immediate success rate of 37.5%, intercostal drainage in 49 cases, and by rest alone in 16 cases. CONCLUSION: In case of secondary pneumothorax, aspiration appeared to offer advantages as an initial strategy over intercostal drainage in terms of hospital stay (11 versus 22 days), and with significant effectiveness (37.5%).

[Silicotuberculosis]. / La silicotuberculose.

OBJECTIVE: Tuberculosis is a serious and common complication of silicosis. The aim of this study is to describe the epidemiological, clinical, radiological and progressive aspects of this pathological entity. PATIENTS AND METHODS: The study concerns 23 cases of silicotuberculosis which were collected at the service of respiratory diseases at CHU Ibn Rochd of Casablanca, Morocco during 12years (2003-2015). RESULTS: All patients were men. They were 7 diggers, 5 rock crushers, 7 miners and 4 masons. The mean duration of silica exposure was 11years. The symptomatology was dominated by dyspnea and persistent bronchial syndrome. Imagery showed tumor-like opacities in all cases, associated with mediastinal calcified lymphadenopathy in 9 cases, with micronodules in 8 cases and an excavated opacity in 2 cases. The diagnosis of tuberculosis was confirmed by isolation of the Koch's bacillus in sputum in 13% of cases in the bronchial aspirate in 52% and culture in sputum post-bronchoscopy in 13%. The bronchial biopsies confirmed the diagnosis in 2 cases. Tuberculosis had complicated silicosis 9years on average after the cessation of exposure to silica in 65% of cases. The antituberculous treatment was started in all patients with good clinical outcome in 22 cases. We had deplored a case of death by acute respiratory failure. CONCLUSION: Silicosis increases the risk of tuberculosis, hence the importance of TB screening in all patients with silicosis.

Chronic pulmonary aspergillosis: a frequent and potentially severe disease.

INTRODUCTION: Chronic pulmonary aspergillosis is a pulmonary fungal infection with various presentations that can occur on a pre-existing cavity, often a sequel of tuberculosis. The objective of our study was to report the diagnostic and therapeutic management of pulmonary aspergilloma in our structure. PATIENTS AND METHODS: We retrospectively studied 81 cases of pulmonary aspergilloma having occurred in the respiratory diseases unit of the Casablanca Ibn Rochd hospital, over 11 years. RESULTS: We included 48 male and 33 female non-immunocompromised patients, with an average age of 51 years (27-75). A history of tuberculosis was recorded in 78 cases. Hemoptysis was the revealing symptom in 73 cases. A characteristic "bell-like" image was observed in 25 cases. The serological results were positive for aspergillus in 54 cases. The treatment was surgical in 50 cases and medical in 24 cases. Five patients died. DISCUSSION: A significant number of pulmonary aspergilloma cases were recorded in our study, occurring most frequently on sequels of tuberculosis. This disease is currently common in countries highly endemic for tuberculosis; early and adequate management is required. CONCLUSION: Aspergillosis is a frequent and potentially severe disease occurring on pre-existing lesions, most often in our context sequels of tuberculosis. Surgical resection is the reference treatment but is the cause of a significant morbidity and mortality. Preventive measures are mandatory.

[Attitudes and behavior in relation to smoking among medical students in Casablanca in 2010]. / Comportement des étudiants en médecine de Casablanca vis-à-vis du tabac en 2010.

OBJECTIVE: Smoking is a major public health problem. The doctor should be at the forefront in the fight against tobacco. Our study aims to determine the prevalence of smoking among medical students and to evaluate their attitudes towards this problem. PATIENTS AND METHODS: A cross-sectional survey was conducted among 736 medical students enrolled in the faculty of medicine and pharmacy of Casablanca in the academic year 2009/2010. RESULTS: The prevalence of smoking was 7.9%. It was significantly higher in men (16% against 3% in women) and varied little from one age group to another (7-8%). The average number of cigarettes smoked per day was eight. More than half of the students (58%) had attempted to quit smoking. The main motivation was the occurrence of certain symptoms (66%). Ex-smokers accounted for 10% of the total. Moroccan anti-smoking law was poorly understood by more than half of our students (72%). The majority was in favor of prohibition of tobacco sales to children (92%) and the training of health professionals to help patients who want to quit smoking (86%). CONCLUSION: Compared with previous years this study shows a marked decrease in the prevalence of smoking among medical students in Casablanca as well as a better understanding of its ill effects. This is due not only to greater awareness of this problem among medical students but also to the introduction of the teaching of the pathologies related to tobacco.

[Varicella pneumonia associated with bilateral pleurisy in an immunocompetent adult]. / Pneumonie varicelleuse associée à une pleurésie bilatérale chez un adulte immunocompétent.

Chickenpox is a viral infection usually benign and practically mandatory of the childhood. In the adult, it may know multivisceral complications as pneumonia in relationship with chickenpox which is the most frequent. One case of varicella pneumonia with a bilateral pleurisy has been noticed in a 38-year-old adult. The definite diagnosis has been based on clinical, biological and radiological arguments. Under an antiviral treatment, the evolution is favourable.

[Scarf pin: an intrabronchial foreign body who is not unusual]. / Épingle à foulard : un corps étranger intrabronchique qui n'est plus inhabituel.

OBJECTIVE: Inhalation of foreign bodies is rare in adults. Inhalation of scarf pin is a phenomenon more frequent in the female population in Morocco. The aim of our study was to describe the characteristics of this particular foreign body and illustrate the circumstances and consequences of its inhalation. PATIENTS AND METHODS: Twenty-six young patients, all veiled, were hospitalized in the service of Respiratory Diseases University Hospital Ibn Rushd of Casablanca between January 2005 and July 2011 for inhaled scarf pin. RESULTS: The mean age was 16 years. Inhalation was accidental in all cases, whereas patients initiated to wear the veil. The penetration syndrome was found in all cases. Clinical examination was normal in all patients. The chest X-ray showed the foreign body as a linear opacity, located right in 18 cases and left in eight cases. Flexible bronchoscopy was able to extract the pin in 21 cases. The pin was released spontaneously in three cases and two patients were operated on. CONCLUSION: The scarf pin is a foreign body especially more common in women who wear the Islamic veil. Flexible bronchoscopy is an essential means of therapy, but the best preventive treatment is avoiding to put in the mouth sharp objects.

CD24(-/low) stem-like breast cancer marker defines the radiation-resistant cells involved in memorization and transmission of radiation-induced genomic instability.

A growing body of evidence attributes properties of chemo- and/or radiation-resistance to cancer stem cells (CSCs). Moreover, non-targeted delayed effects such as genomic instability, transmitted through many generations, can be observed in the progeny of surviving irradiated cells. As a consequence, we propose that radiation-resistance properties associated to CSCs could confer a key role to this subpopulation in the transmission of genomic instability. To test this hypothesis, we searched the CSC markers associated to radiation-resistance in breast cancer cell lines and studied the role of the resistant cells in the transmission of genomic instability. First, we show that irradiation induces a 2-4 weeks period of intense cell death leading to the emergence of chromosomal unstable cells during more than 35 population doublings. Then, among seven breast CSC markers, we identify CD24(-/low) labelling as a marker of radiation-resistance. We demonstrate that CD24(+) progeny of irradiated cells exclusively descends from CD24(-/low) cells. Finally, we show that delayed chromosomal instability is only expressed by CD24(+) cells, but is transmitted by stable surviving CD24(-/low) cells. So, for the first time a CSC marker, CD24, is associated with the transmission of genomic instability. This work may assign a new deleterious role to breast CSCs in aggressive recurrence after radiotherapy, as the transmitted genomic instability potentially leads tumour cells to acquire more aggressive characteristics.

Profile of multiple system atrophy in Moroccan patients attending a movement disorders outpatient clinic in Rabat university hospital.

INTRODUCTION: Multiple system atrophy (MSA) is a sporadic and rapidly progressive neurodegenerative disorder of poor prognosis, characterised clinically by any combination of parkinsonian, autonomic, cerebellar, or pyramidal signs. We report our experience in movement disorders consultation concerning the clinical presentation and the course of MSA in Moroccan patients. METHODS: A retrospective review of the medical records of 17 patients with diagnosis of MSA seen in our outpatient clinic from January 2007 to December 2010. RESULTS: In our 17 patients, 76.5% were men and the mean age of onset was 52±9 years. MSA-P was the major clinical phenotype (82.4%). Eleven patients (64.7%) were classified as having probable MSA and six patients (35.3%) as possible MSA. Dysautonomic features were detected in all patients; urinary symptoms were found in 76.5% of cases and orthostatic hypotension in 64.7%. Treatment regimen included l-Dopa with a mean daily dose of 621.4±346.8mg/day and symptomatic treatment of dysautonomia. The mean duration of disease evolution was of 4.7±1.9 years. DISCUSSION: Our results show a male predominance and an early age of disease onset. MSA-P was the predominant subtype. Our results are similar to the European MSA series. CONCLUSION: Multicentre studies are needed to better characterise MSA in Morocco given the rarity of this disease.

[Cardiac thrombosis, pulmonary artery aneurism and pulmonary embolism revealed Behçet's disease]. / Thrombose cardiaque, anévrisme de l'artère pulmonaire et embolie pulmonaire révélant une maladie de Behçet.

Intracardiac thrombosis is a rare complication of Behçet's disease. It may be isolated or associated with arterial disease. We report a case of a patient from northern Morocco, aged 23, without specific medical history. He consulted for recurrent hemoptysis of middle abundance, associated with bipolar aphthosis. Chest radiography showed a left basal opacity fuzzy and right paracardiac opacity. The thoracic CT objectified left segmental lower lobe embolism, an aneurysm of a segmental branch of the right lower lobe and right intraventricular thrombus. Echocardiography confirmed the intracardiac thrombus. The patient was treated by oral corticosteroids, azathioprine, colchicine, and anticoagulants. The outcome was favorable with complete resolution of intraventricular thrombus and the aneurysm.

[Anatomical snuffbox lipoma causing nervous compression. A case report]. / Lipome compressif de la tabatière anatomique. À propos d'un cas.

Lipomas are rarely localized at the hand, and more unfrequently at the anatomical snuffbox. We report a case of a lipoma that compressed the lateral branch of the superficial sensory branch of the radial nerve.

[Sympathetic response in primary hypertension]. / Les réponses sympathiques dans l'hypertension artérielle essentielle.

UNLABELLED: High blood pressure (BP) is a major cause of cardiovascular disease and primary hypertension is a frequent pathological condition. Sympathetic hyperactivity may be involved in primary hypertension. The purpose of this study was mainly to evaluate sympathetic activity when performing cardiovascular autonomic profile examination in patients with primary hypertension in comparison with normotensive subjects. PATIENTS AND METHODS: This prospective study included one group of hypertensive patients (n=120, mean age 54 years) compared with a control group (n=120, mean age 52 years) of normotensive subjects. Autonomic tests included deep-breathing (DB), hand-grip (HG) and echostress test (ES). Comparison tests between the two groups, similar in age, were expressed as mean+/-SE and made using the t Student test, p<0.05 was considered significant. RESULTS: Alpha-adrenergic sympathetic response using ES method produced a BP response of 20,0%+/-9,8 in hypertensive patients group and 15,2%+/-8,6 in the control group (p<0.001). Alpha-adrenergic sympathetic response using three minutes HG test was of 16,7%+/-7,5 in hypertensive patients group and 13,3%+/-6,5 in the control group (p<0.001). Vagal stimulation in hypertensive group after DB showed that electrocardiographic: ECG (EKG) waves R (RR) interval variation was of 30,2%+/-8,1 meanwhile in the control group this RR variation was of 46,1%+/-21,1 p<0.001, and the one of HG of 15 seconds was 17,6%+/-10,2 versus 32,5%+/-12,7 p<0.001. CONCLUSION: Hypertensive patients had a significantly higher sympathetic response to central and peripheral stimulations and a significantly lower parasympathetic response when compared to normotensive controls.

[Evaluation of the vagal activity by the Deep-Breathing test]. / Evaluation de l'activité vagale par le test de la respiration profonde (Deep-Breathing).

OBJECTIVE: The Deep-Breathing (DB) test is of major importance in the evaluation of the vagal response (VR). We applied this test to assess the VR in a group of subjects with functional (neurological, cardiovascular or digestive) symptoms unexplained by standard cardiac examination and to compare it with the VR measured in a group of healthy controls. PATIENTS AND METHODS: The following groups were considered: a C-Group of healthy controls (n=50), and three groups each consisting of 50 symptomatic patients (S1, S2, S3). Subjects in the S1-Group had a postural orthostatic tachycardia syndrome (POTS), while members of the S2-Group had arterial hypertension, and members of S3-Group had neither POTS nor arterial hypertension. The VR was expressed as a percentage variation of RR intervals 100x[(RR(max)-RR(min))/RR(min)], and was correlated with age and sex in the C-Group before any comparison. RESULTS: In controls the VR was 31.0%+/-8.2. It was negatively correlated with age (r=-0.42, p=0.003) and there was no significant difference between males (31.2%+/-5.7) and females (30.9%+/-9.0) (p=0.12). Compared to the C-Group, the VR was 51.6%+/-20.4 in the S1-Group (p<0.001), 26.9%+/-11.3 in the S2-Group (p<0.001), and 47.2%+/-22.7 in the S3-Group (p<0.001). CONCLUSION: The VR was independent of sex but was negatively correlated with age. In comparison with healthy controls, it was significantly increased in the patients with POTS and significantly decreased in hypertensives.

[Autonomic profile of patients with migraine]. / Profil autonomique des patients migraineux.

OBJECT: Dysfunction of autonomic nervous system (ANS) is implicated in the genesis and persistence of migraine. The objective of this study was to compare autonomic nervous system (ANS) profile of migraineurs during headache-free periods to a group of normal subjects based on cardio-vascular reactivity. METHODS: Patients with migraine according to the criteria of IHS 2004 were selected for the study. After a 30 min resting blood pressure (BP), the following standard tests were performed: deep-breathing (DB), hand grip (HG) of 15 s and 3 min, valsalva maneuver, echo stress, (ES) and tilt test (TT). Results were compared to 44 normal subjects, age similar, 37 female, (84.1%) using the Student test, with P < 0.005 as significant. RESULTS: Thirty-two patients (27 female (84.38%), 16-51 years, mean 40.41 +/- 7.8) were studied. Twenty-two patients (69%) had systolic blood pressure below 94 mmHg and 25 patients (78%) had diastolic blood pressure below 60 mmHg. Compared to normal, migraineurs exhibited a significantly higher vagal response (P < 0.001) and a significantly lower alpha sympathetic response, central by using ES as well as peripheral by using HG of 3 min (P < 0.001). CONCLUSIONS: Autonomic cardiovascular reactivity of patients with migraine showed a vagal hyperactivity and a deficiency of the alpha sympathetic system. This leads to further studies with new therapeutical approaches.