A case of PRES in an active lupus nephritis patient after treatment of corticosteroid and cyclophosphamide.

Posterior reversible encephalopathy syndrome (PRES) is primarily a radiological diagnosis. The syndrome is characterized by headache, altered mental status, seizures, and bilateral posterior white matter edema in a nonvascular distribution on neuroimaging with resolution of findings usually in 7-14 days (Casey et al. in AJNR Am J Neuroradiol 21:1199-1206, 2000). In most cases, computed tomography of the brain will show hypodense lesions in the parieto-occipital lobe. Although this syndrome is uncommon, prompt and accurate recognition allows early treatment, which has been shown to produce favorable outcomes. It is hypothesized that the dysfunction can be caused by a failure of autoregulation systemic hypertension or by the cytotoxic effects of vasculitides and immunosuppressive drugs. The present report is a possible second case of cyclophosphamide-induced PRES in a 16-year-old girl with systemic lupus erythematous and lupus nephritis. The initial suspected diagnosis was an ischemic stroke, but it was later changed, with resolution of symptoms after management of the underlying cause.

Prevalence and risk factors of cognitive dysfunction in chronic hemodialysis patients.

OBJECTIVES: There is growing evidence for cognitive dysfunction in chronic hemodialysis patients as the age and the prevalence of comorbidities increase in this population. The aim of the present study was to assess cognitive performance in hemodialysis patients and determine the variables associated with poor cognitive function. METHODS: Cross-sectional cohort of 108 maintenance hemodialysis patients in the Marrakech area. Cognitive performance was assessed through the mini mental state examination (MMSE). Cognitive impairment was defined as a score of less than 24. Univariate and multivariate analyses were performed to determine the variables associated with MMSE score. RESULTS: We found that 25% of the subjects were cognitively impaired. After adjusting for demographic and medical variables, low MMSE scores were independently associated with educational level (odd ratio: 0.564; p = 0.031) and anemia (odd ratio: 0.743; p = 0.046). CONCLUSION: There is a high prevalence of cognitive dysfunction among hemodialysis patients and many causative factors have been evoked. Effective identification of this trouble allows adequate psychological interventions to improve the quality of life of these patients.

University hospital doctors: what are their beliefs about organ donation?

INTRODUCTION: Organ and human tissue donation is not well developed in Morocco. This is due in part to the refusal of families, but also to a lack of awareness. We conducted a survey of a representative sample of doctors more exposed to the donation process to assess their knowledge and attitudes toward organ donation and their training needs. METHODS: This is a cross-sectional study of physicians in Marrakech University Hospital. An anonymous questionnaire adapted to Moroccan context, assessing the knowledge, opinions, attitudes, and needs regarding organ donation was given to doctors. RESULTS: Among 130 distributed questionnaires, we collected 115 completely answered surveys. Respondees were as follows: 60.8% were females, 87 were residents and 28 interns, 80% were aged from 25 to 34 years, and 60% had practiced their profession for 1 to 5 years. Results showed that 28% don't know that tissue and organ donation from a cadaver is authorized in Morocco, 6% are aware of the organs and tissues that can be taken, 76% know the definition of brain death, 35% don't believe in this concept, 88% were favorable for the removal of organs and tissue of deceased persons, 10% ignore that Islam allows organ donation, 62% will give their organs and tissues after death, 25% refuse organ donation of a parent, and 30% refuse it of their children after death. CONCLUSIONS: Our findings show that there is discordance between knowledge and attitudes of doctors in our hospital toward organ donation. The promotion of organ donation requires good training of our teams to sensitize the population.

Knowledge and attitudes of Moroccan hemodialysis patients toward renal transplantation: did we inform our patients enough?

BACKGROUND: Chronic kidney disease is a worldwide public health problem. It is essential to offer patients all appropriate and available treatment options. However, it seems that nephrologists do not talk enough about renal transplantation to their patients. AIM: This pilot study assessed the knowledge, attitudes, and beliefs of hemodialysis patients related to renal transplantation. METHODS: The research included 120 hemodialysis patients from three centers. The instrument was a structured questionnaire completed in individual interviews. None of the respondents had been transplanted. The subjects addressed in the document were sociocultural status, willingness to be transplanted, ability to identify major benefits and risks of renal transplantation, and knowledge of religious attitudes toward living and cadaveric organ donation and transplantation. RESULTS: Among the 120 patients were 53.3% women with an overall mean age of 50.5±10.3 years. The mean duration of hemodialysis was 7.7±5.8 years. Only 15% were highly educated, and 55% had a moderate economic status. Of the 120 respondents, 76% stated that they were willing to be transplanted. However, 41.7% thought that transplantation was more expensive than hemodialysis. Only 65.8% believed that renal transplantation offered a better quality of life. They were afraid of multiple complications and return to dialysis. Of the 120 respondents, 65.9% believed that Islam is adverse to cadaveric donation, a rate that fell to 35.8% concerning living donors. Fifty-four percent of respondents stated that they wanted to obtain more information about renal transplantation. CONCLUSION: There is a need to increase awareness about organ donation and transplantation among hemodialysis patients and their families.

Goodpasture's syndrome - four case reports.

Goodpasture's syndrome (GPS) is a rare but severe immunological disease, which is characterised by rapidly progressive glomerulonephritis and intraalveolar hemorrhage (IAH) with the presence of anti-glomerular basement membrane (GBM) antibodies. We report four cases of GP's syndrome referred to the nephrology unit at Ibn Rochd UHC in Casablanca from January 1995 to December 2003. All patients had rapidly progressive glomerulonephritis (RPGN) with proteinuria and microscopic hematuria. Elevated blood pressure was noted in one case. IAH was manifested as hemoptysis in two cases, radiological signs in three cases and confirmed by broncho-alveolar lavage in all cases. Laboratory assessment revealed anemia in all cases. Renal biopsy showed extracapillary glomerulonephritis with linear deposits of IgG along the GBM. Renal failure was severe and hemodialysis was required in all cases. All patients were treated with prednisone and cyclophosphamide and none recovered renal function. Two patients died due to severe lung hemorrhage.