C-Reactive Protein, Ferritin, and Procalcitonin in 300 Moroccan Patients with COVID 19.

BACKGROUND: COVID-19 is a true global pandemic since March 2020, and it is responsible in the majority of patients mild symptoms; however, a small number of patients progress to the severe form with acute respiratory distress syndrome (ARDS) and some of them progress to the very severe form which can be fatal when it comes to multiorgan failure. Thus, it is important to identify as early as possible patients at high risk of progressing to severe forms requiring early and specialized management in order to reduce mortality. METHODS: Our five-month retrospective study (May 2020 - October 2020) included 300 SARS-CoV-2 patients confirmed by RT-PCR and hospitalized in the Infectious and Tropical Diseases Center (CMIT), and in the Intensive Care Unit of the Military Hospital of instructions Mohamed V of Rabat (Morocco). Our objective was to compare the levels of C-reactive protein (CRP), ferritin, and procalcitonin (PCT) according to the clinical state and prog-nosis of patients. RESULTS: In our series of results, very significantly elevated levels of C-reactive protein, ferritin, and procalcitonin were associated with severe and very severe forms of COVID-19 disease as well as a poor prognosis. CONCLUSIONS: In the absence of international recommendations, the validation of clinical-biological scores involving different biological parameters in COVID-19 patients would allow a standardization of practices, a correct prescription of biological analyses and a risk stratification allowing to palliate the lack of medical resources and thus to reduce mortality.

Interpretation Difficulties of Serum Immunofixation Test in Immunoglobulin D Multiple Myeloma with Hidden Lambda Light Chains.

BACKGROUND: We report a case of immunoglobulin (Ig) D myeloma with hidden lambda light chains in a patient whose immunofixation test was very difficult to interpret: the IgD reacts with the anti-δ heavy chain antiserum but does not react with anti-lambda antiserum. The band in the D heavy chain lane is unmatched in light chain lanes and the band in lambda light chain lane migrates higher. METHODS: To distinguish between heavy chain disease and immunoglobulin with "hidden" light chains, the sample was exposed to a very high concentration of anti-lambda and anti-kappa antisera for 48 hours. RESULTS: The serum immunofixation test of the sample treated with anti-lambda showed a decrease in the intensity of the band corresponding to D heavy chain lane as well as the modification of its mobility confirming the presence of IgD with the hidden lambda light chains. CONCLUSIONS: The IgD myeloma with hidden light chains remains a rare entity, hence the interest of sensitizing health professionals to be vigilant and ensure a good diagnosis. The proposed technique is useful, simple, reliable, and less laborious than those previous reported in the literature. Medical laboratories using Sebia-Hydrasys® system should be aware of the described phenomenon in order to avoid identifying an IgD myeloma as a delta heavy chain disease.

[Comparing two screening policies of gestational diabetes mellitus: The Mohammed V Training Military Hospital of Rabat (Morocco)]. / Comparaison de deux politiques de dépistage du diabète gestationnel: expérience de l'hôpital militaire d'instruction Mohammed V de Rabat (Maroc).

OBJECTIVES: We wanted to measure the impact of going from a two-step screening for gestational diabetes mellitus (50g oral glucose tolerance test then 100g OGTT) to a one-step screening 75g OGTT (WHO's recommendations). PATIENTS AND METHODS: A prospective study was carried out among patients who consulted between July 1st, 2008 and October 31st, 2009. The screening was performed in the first trimester if risk factors were identified and between 24 and 28 weeks of gestation (WG). RESULTS: During our period of study of 15 months, 706 pregnant women were included. The prescription of a screening test was performed in 403 women, i.e. 57% of cases. Out of the 403-screened women, 33 had gestational diabetes mellitus (GDM) i.e. a 8.2% prevalence rate. In univariate analysis, the following are considered to be risk factors: age, diabetes family history and macrosomia history in a previous pregnancy. Between 24 and 28 WG, 34.34% of the screening tests were achieved. The 75g OGTT is prescribed in 96.2% of cases as a screening test of GDM but fasting blood glucose is still prescribed in 3.8% of cases. Also, before 12 WG, 75g OGTT represent 64.7% of the prescribed tests. DISCUSSION: Despite the simplification of the GDM screening procedure, our work shows no significant difference of the screening rate and prevalence of GDM between our present study and the first work done in the same service (57% versus 61%, P=0.7 and 8.2% versus 7.7%, P=0.9). The GDM risk factors found are also identical between the two studies: age, type 2 diabetes family history and macrosomia history. Moreover, there is a statistically significant improvement in the screening age (23±6.7 versus 20.9 WG±6.8 in the first half of 2008, P<0.001) and the number of tests ordered during the period between 24 and 28 WG (34.34% versus 23.9% in the first half of 2008, P<0.001). For the GDM screening tests between 24 and 28 WG, 75g OGTT replaced the 50g OGTT (test used in the first study), but fasting blood glucose is prescribed in 3.8% of cases knowing that normal fasting blood glucose alone done between 24 and 28 WG has a poor sensitivity and do not exclude the diagnosis of GDM (Cosson, 2006) [11]. Also, before 12 WG, 75g OGTT represents 64.7% of the prescribed tests. However, there is to date no data to validate load testing before 24 WG. CONCLUSION: Our comparative study revealed maintenance of low implementation of universal screening of GDM despite the simplification of the protocol. Between 24 and 28 WG, 75g OGTT replaced the 50g OGTT, but fasting blood glucose was still prescribed. A sensitization meeting involving all intervening persons is to be organized with proposals for corrective actions. The final objective is the systematic screening of gestational diabetes mellitus with the use of fasting blood glucose in the first trimester and the 75g OGTT between 24 and 28 weeks of gestation.

[Association between bone turnover markers, bone mineral density and vitamin D in Moroccan postmenopausal women]. / Association entre les marqueurs du remodelage osseux, la densité minérale osseuse et le statut vitaminique D chez des femmes ménopausées d'origine marocaine.

UNLABELLED: The aim of the study is to find the correlation between bone turnover markers and bone mineral density in a cohort of Moroccan postmenopausal women. PATIENTS AND METHODS: A cross-sectional study, conducted over a period of 12 months from October 2008 to November 2009. Five hundred Moroccan postmenopausal women volunteers participated in this study and we included only 185. RESULTS: In this cohort of 185 women, average age 60 years, the percentage of osteoporotic women was 35.7%, they were older 62.09 (9.13) years and they had an average of the body mass index (BMI), the lowest 29.58 (4.45). The values of the bone mineral density (BMD) measured at the lumbar spine correlated positively and significantly with BMI (P<0.001), serum calcium (P=0.026), negatively with age (P<0.001) and osteocalcin (OC) (P=0.0033). As for the results of BMD measured at the femoral neck, they show a negative and highly significant correlation with age (P<0.001) and osteocalcin. Looking for an association between the biochemical markers of bone remodeling, a weak positive correlation was found between the calcium (Ca) and alkaline phosphatase (PAL) on the one hand and Ca and intact parathyroid hormone (PTHi) in the other hand. And a significant positive correlation was found between PTHi and PAL, and between PTHi and OC. Finally, a significant positive correlation was found between the cross-laps (ß-CTX) and Ca and between PAL and OC. CONCLUSION: Our results are in agree to some international studies and disagree to others.

Monoclonal gammopathies in a Moroccan military hospital.

The aim of this study was to describe biological features and aetiology of monoclonal gammopathy diagnosed during a 10-year period in the biochemistry department of the Moroccan Military Hospital Mohamed V in Rabat. The study was performed from 1 January 2000 to 31 December 2009. The records of 261 patients living in the Rabat area in which either serum protein electrophoresis and serum and/or urine immunofixation were performed at the biochemistry department of Military Instruction Hospital in Rabat were analysed. A cohort of 182 (70%) men and 79 (30%) women, the mean ± SD (range) ages were 60.21 ± 12.56 years. All patients were Caucasian. Electrophoresis found that 211 (80.84%) of the patients had a monoclonal gammopathy. Immunofixation confirmed that 251 (96.17%) patients had a monoclonal band in serum. In our cohort, MM was the most frequent diagnosis, our patients were late diagnosed.

Intérêt des marqueurs tumoraux sériques dans les cancers digestifs

Les marqueurs tumoraux sont des composés produits par les cellules cancéreuses ou leur environnement se retrouvant en quantité suffisante dans le sang, les urines et les liquides d'effusion. Les marqueurs les plus utilisés en pathologie digestive sont l'antigène carcino-embryonnaire (ACE), l'alpha foetoproteine (_FP) et le CA19-19. Le but de notre travail est de discuter l'intérêt de ces trois marqueurs dans le dépistage, le suivi et le pronostic des cancers gastriques, pancréatiques, colorectaux et hépatiques.La faible sensibilité et l'existence de faux positifs rendent parfois ces marqueurs impropres à une stratégie de dépistage. Par contre, seul l'_FP a une valeur diagnostique dans les hépato carcinomes pour les populations à haut risque. L'ACE et le CA19-9 ont une bonne sensibilité et une spécificité relative qui leur permettent de suivre l'évolution des cancers digestifs en particulier les cancers colorectaux. Ils constituent les meilleurs marqueurs pour évaluer le pronostic, l'efficacité thérapeutique et pour dépister les récidives de façon précoce. Leur association est justifiée et permet d'atteindre 91% de spécificité et 76% de sensibilité.Devant la place occupée par la biologie dans le diagnostic, le pronostic et le suivi des cancers digestifs par le dosage des marqueurs tumoraux, nous nous devons que de reconnaître tant leurs performances que leurs limites

[A critical study of the screening practices of gestational diabetes of a service of gynecology and obstetrics]. / Etude critique des pratiques de dépistage du diabète gestationnel d'un service de gynécologie obstétrique.

Our study has for aim to describe the practices of screening of the gestational diabetes mellitus. Screening test was realised at 61% of the women included in the study. The HGPO in 50 g was prescribed in 47% of the cases, a single fasting blood glucose in 28% of the cases; 13,4% of the detected women had a glycaemia included between 1,30 and 2 g/L one hour after a load of 50 g of glucose. Among these patients, 52,63% did not realize test HGPO in 100 g. Gestational diabetes mellitus complicates about 7,7% of pregnancies in our study. In statistical analysis united varied, are considered as risk factors: the age, the family history of diabetes and the histories of macrocosmic during previous pregnancy.

[Biological profile of type I allergies at Mohamed V Hospital (Rabat- Morocco)]. / Profil biologique des allergies de type I chez les consultants de l'hôpital Mohamed V de Rabat.

Allergic diseases are ranked fourth considering the world health organization classification of diseases. The consequences linked to these ailments are huge for public health economics and the diagnosis is awkward due to clinical polymorphism and multifactorial aetiologies. The allergologic diagnosis is the result of weighing in clinical and biological findings. The biological assessment is made of qualitative specific and multiple-allergen serum IgE test, which once positive drives to skin test and each allergen-specific IgE level determination to conclude. Our study aims at displaying biological analysis results of incoming patients with clinical allergy conditions. We carried out a nine months retrospective study, from June 2007 to March 2008, with 200 outwards patients involved. Blood samples were collected using dry tubes and as recommended we first did screening tests for respiratory (Pharmacia Phadiatop) and food (fx 5) allergens, then for positive samples we proceeded to serum specific IgE assay (UniCap, Phadia). We also realized the total IgE assay on 46 patients using Roche Elecsys 2010 technology. 49% of patients enrolled in the study were positive to aerollergens, d1 Dermatophagoides pteronyssinus being the most incriminated (96.4%), and 2.5% to food allergens. On 13% of patients, we noticed a double sensitization to d1 and g6 (pollen of grasses). Concerning the total IgE dosage, we found 50% of patients tested with normal values, 28% of whom having a positive allergologic screening test. Further studies matching clinical data, skin tests to serum IgE assay are necessary to draw the profile of respiratory and dermatological allergies for our patients.

[Kidney vasculitis connected to cryoglobulinemia IIA and hepatitis B]. / Vascularite rénale dans le cadre d'une cryoglobulinémie mixte associée au virus de l'hépatite B.

We report the case of a 70 years old patient hospitalized for renal insufficiency and deterioration of the general state. The electrophoresis of serum proteins on freezing of agarose reveals the presence of a discrete peak of monoclonal pace on the level of the gammaglobulines identified by serum immunofixation like IgM of the kappa type. The research of the cryoglobulinemia carried out in a laboratory of city was made positive and typified like a monoclonal cryoglobulinemia IgM kappa, thus directing the diagnosis towards a disease of Waldenström. However, the result of the biopsy medullary made exclude any lymphoprolifératif syndrome. The positivity of the serology of hepatitis B justified a second request for study of the cryoglobulinemia, carried out within our laboratory. The cryoglobuline was typified like mixed (IgM kappa monoclonal and IgG polyclonales). This result associated with the immunological assessment and the renal biopsy made retain for our patient the diagnosis of a kidney vasculitis connected to an infection chronicle by the virus of hepatitis B. This observation points out the interest of the preanalytic, analytic and post analytic phases in the study of the cryoglobulinemias. A good technical control is today the only guarantee of the quality of the result of this examination which has large importance in internal medicine in the etiologic assistance with the diagnosis of certain clinical demonstrations.

[Contribution of the laboratory to the evaluation of brain-dead patients for obtaining organs from dead individuals]. / Apport du laboratoire dans l'évaluation des patients en mort encéphalique en vue d'un prélèvement d'organes sur la personne décédée.

The removal organ in order to transplantation is realized often for patient deceased. It was regulation activity that passes in urgency context where laboratory play an important role. The biochemistry, immunology, haematology, toxicology and microbiology analysis allows the validation of the donors, the supervision of the functional quality of organ and the definition of the best couple donor-recipient.