[To what extent Africa can limit the impact of the COVID-19 pandemic?] / Jusqu'où l'Afrique peut-elle limiter l'impact de la pandémie de COVID-19 ?

Following the onset of the global COVID-19 pandemic and the alerts issued by the World Health Organization, for several months attention has been focused on Africa as a potentially severely endangered continent. A sizable number of African countries, mainly low and middle income, suffer from limited available resources, especially in critical care, and COVID-19 is liable to overwhelm their already fragile health systems. To effectively manage what is shaping up as a multidimensional crisis, the challenge unquestionably goes beyond the necessary upgrading of public health infrastructures. It is also a matter of anticipating and taking timely action with regard to factors that may mitigate the propagation of SARS-CoV2 and thereby cushion the shock of the pandemic on the African continent. While some of these factors are largely unmanageable (climate, geography…), several others (socio-cultural, religious, audio-visual, and potentially political…) could be more or less effectively dealt with by African governments and populations.

Atypical celiac disease: from recognizing to managing.

The nonclassic clinical presentation of celiac disease (CD) becomes increasingly common in physician's daily practice, which requires an awareness of its many clinical faces with atypical, silent, and latent forms. Besides the common genetic background (HLA DQ2/DQ8) of the disease, other non-HLA genes are now notably reported with a probable association to atypical forms. The availability of high-sensitive and specific serologic tests such as antitissue transglutuminase, antiendomysium, and more recent antideamidated, gliadin peptide antibodies permits to efficiently uncover a large portion of the submerged CD iceberg, including individuals having conditions associated with a high risk of developing CD (type 1 diabetes, autoimmune diseases, Down syndrome, family history of CD, etc.), biologic abnormalities (iron deficiency anemia, abnormal transaminase levels, etc.), and extraintestinal symptoms (short stature, neuropsychiatric disorders, alopecia, dental enamel hypoplasia, recurrent aphtous stomatitis, etc.). Despite the therapeutic alternatives currently in developing, the strict adherence to a GFD remains the only effective and safe therapy for CD.

Epidemiologie et profil de sensibilite des isolats d'hemocultures dans un centre hospitalo universitaire marocain

Introduction : L'antibiotherapie des bacteriemies est generalement empirique dans les premieres 48 heures; fondee sur les connaissances epidemiologiques prealables et sur la frequence de sensibilite aux antibiotiques des bacteries en cause. Objectif : L'objectif de cette etude est de determiner le profil epidemiologique et la sensibilite aux antibiotiques des bacteries isolees des hemocultures dans un centre hospitalo-universitaire; afin d'optimiser l'antibiotherapie probabiliste des bacteriemies en milieu hospitalier.Materiels et Methode : Il s'agit d'une etude descriptive realisee sur une periode de 18 mois; allant de janvier 2008 au juin 2009 au niveau du laboratoire de Microbiologie du CHU Mohammed VI de Marrakech. Resultats : Cent quarante six souches bacteriennes non repetitives ont ete colligees; les bacilles a gram negatif ont represente 52;7. Les especes les plus frequemment isolees etaient Staphylococcus aureus (21;3); Enterobacter cloacae (14); Acinetobacter baumannii (12;3) et Pseudomonas aeruginosa (8;9). La resistance a l'oxacilline etait de 48;3pour Staphylococcus aureus. Aucune souche resistante aux glycopeptides n'a ete trouvee chez les souches d'enterocoques et de staphylocoques isolees. Les enterobacteries etaient resistantes aux cephalosporines de troisieme generation dans 64;3des cas avec un phenotype de betalactamase a spectre elargi. La proportion de bacilles a Gram negatif non fermentaires resistants a l'imipeneme etait de 49;9. Conclusion : Une surveillance epidemiologique des bacteriemies en milieu hospitalier est necessaire pour mieux guider l'antibiotherapie probabiliste

Clinical and immunological status of a newly diagnosed HIV positive population, in Marrakech, Morocco.

OBJECTIVE: To evaluate the clinical and the immune status of newly HIV diagnosed patients, in Marrakech city and its neighboring area, in Morocco. METHODS: We performed a retrospective study on 235 patients who have been previously confirmed for HIV infection, and underwent a CD4 T cells using flow cytometry (FacsCount, Becton Dickinson®). RESULTS: The mean age of patients was 34,3 ± 8,4 years (range: 14-55), with a male predominance (sex-ratio M/F=1.4). On basis of clinical data of the patients, 62% (n=146) of them were categorized as "category C", 18.4% (n=43) as "category B", and 19.6% (n=46) as "category A" according to CDC (Center for Disease Control) HIV classification. Among all of them, 60.4% (n=142) had less than 200 CD4T cells, 26% (n=61) had between 200 and 499 CD4T cells, and only 13.6% (n=32) showed a number of CD4T cells less or equal to 500/mm(3). CONCLUSION: The results of this study reflect a significant delay in the diagnosis of HIV infected patients. Therefore, this delay may compromise timely management of HIV infected individuals and enhances propagation of the epidemic in our country. These data confirm the need for intensifying prevention efforts among high-risk population. Moreover, continuing education in HIV/AIDS among healthcare providers should be reinforced.

[Autoantibodies in systemic sclerosis: clinical interest and diagnosis approach]. / Autoanticorps au cours de la sclérodermie systémique: intérêt clinique et approche diagnostique.

PURPOSE: This review describes different autoantibodies that are associated to systemic sclerosis disease, in presenting their interest for the diagnosis and prognosis, and suggests an immunologic diagnosis approach. The systemic sclerosis (SSc) is characterized by variant specific autoantibodies (autoAbs). More than 90% of SSc cases have antinuclear antibodies (ANA). Anti-centromere and anti-Th/To antibodies are often associated to the limited SSc and to the CREST syndrome. The anti-topo-isomerase I, anti-RNA polymerases and anti-fibrillarin/U3-RNP Abs are diffuse SSc markers with several organ involvements. The anti-PM/Scl and anti-U1-RNP Abs rather mark overlap shapes with polymyositis and systemic lupus erythematous, respectively. The anti-Ku, anti-B23 and anti-NOR90 Abs are a new generation of less frequent autoAbs that show a relationship with specific subsets of SSc. Another heterogeneous group of Abs, topic of research, is described in SSc as well as anti-fibrillin 1, anti-endothelial cells, anti-annexin V and anti-collagen Abs. Despite the diagnosis of scleroderma is mainly clinical, these different autoAbs constitute a diagnosis and prognosis tools by defining immuno-clinical substes of the disease. Identifying those autoAbs requires a diagnostic strategy with two steps: the indirect immunofluorescence remains the better means of ANA tracking, leading thereafter to other identification specific methods, such immunoprecipitation, ELISA or immunoblotting.

[Low prevalence of anti-centromere antibodies in scleroderma in Morocco (about 272 cases)]. / Faible prévalence des anticorps anti-centromère dans la sclérodermie au Maroc (à propos de 272 cas).

PURPOSE: assessment of autoantibodies prevalence during scleroderma within a Moroccan population by a retrospective survey. MATERIAL AND METHODS: 272 patient (220 cases of systemic sclerosis, 45 cases localised scleroderma and 7 cases of mixed connective tissue disease (MCTD)) underwent a screening for antinuclear antibodies (ANA) by indirect immunofluorescence (IFI) on Hep-2 cells, followed, in 127 cases, by anti-extractable nuclear antigen (ENA) antibodies identification using a double immunodiffusion (IDD) method. RESULTS: sixty eight for percent of patients presenting with a systemic sclerosis had positive ANA whose identification revealed: 23 cases (15.3%) of anti-topoisomerase I, 8 cases (5.3%) of anti-centromere (ACA) and 5 cases (3.3%) of anti-U1-RNP antibodies. Out of the 8 cases of ACA, 3 corresponded to a CREST syndrome. Anti-topoisomerase I antibodies were observed in 2 of the 4 patients having an interstitial pulmonary syndrome. Anti-U1-RNP antibodies were present in 3/38 patients (7.8%) having a systemic sclerosis associated to arthritis. 4/45 patients (9%), presenting with a localised scleroderma, had positive ANA, of which 2 were ACA. All patients admitted for MCTD had anti-U1-RNP antibodies, coexisting with anti-Sm antibody in 2 cases. CONCLUSION: the low prevalence of ACA observed in this survey, when compared to American, European and Japanese studies, is probably due to ethnic variation in frequency of ANA. Indeed, low rates or absence of ACA have been reported in south-African, Afro-American, Indian, and Thai studies. The IDD, method of reference for detecting of anti-ENA antibodies, identify a small fraction of anti-nucleolar aspects of scleroderma. Thus, other methods such as ELISA and/or immunoblotting are required to complete their identification.