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The venom from Apis mellifera intermissa , the main honey bee prevailing in Morocco, has been scarcely studied, despite its known potential for pharmacological applications. In the present work, we investigated the composition, the anti-inflammatory activity, and the venom's cytotoxic properties from fifteen honey bee venom (HBV) samples collected in three regions: northeast, central, and southern Morocco. The chemical assessment of honey bee venom was performed using LC-DAD/ESI/MS n , NIR spectroscopy and AAS spectroscopy. The antiproliferative effect was evaluated using human tumor cell lines, including breast adenocarcinoma, non-small cell lung carcinoma, cervical carcinoma, hepatocellular carcinoma, and malignant melanoma. Likewise, we assessed the anti-inflammatory activity using the murine macrophage cell line. The study provides information on the honey bee venom subspecies' main components, such as melittin, apamin, and phospholipase A2, with compositional variation depending on the region of collection. Contents of toxic elements such as cadmium, chromium, and plumb were detected at a concentration below 5 ppm, which can be regarded as safe for pharmaceutical use. The data presented contribute to the first study in HBV from Apis mellifera intermissa and highlight the remarkable antiproliferative and anti-inflammatory effects of HBV, suggesting it to be a candidate natural medicine to explore.

Percutaneous stenting angioplasty of native coarctation of the aorta is considered a low-risk procedure with high success rate. The incidence of cerebral complications, especially ischemic complications, is very low. We report a case of a 15-year-old boy who underwent a percutaneous stenting angioplasty for a coarctation of the aorta and developed a cerebral infraction 4 hours after the procedure., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2021 D. Doughmi et al.)

Levodopa is a dopamine precursor and a mainstay treatment in the management of Parkinson's disease. Its side effects induce dyskinesia, nausea, vomiting, and orthostatic hypotension. Acute levodopa acute poisoning is uncommon, with only a few reported cases in the medical literature. Treatment of poisoning by levodopa is mainly supportive. The case of a child admitted to a hospital for acute levodopa poisoning is presented in this report., Competing Interests: Conflict of interest The authors declare having no conflict of interest., (© 2019 Adnane Lahlou, Saïd Benlamkaddem, Mohamed Adnane Berdai, Mustapha Harandou, published by Sciendo.)

Throughout Morocco, cade oil is used in folk medicine for many purposes, in particular for atopic dermatosis. It is also used as a wormer. Cade oil poisoning of newborns and infants thus often has an iatrogenic origin, resulting especially from the ingestion of a significant amount or from a prolonged and extensive cutaneous application. Thus, this oil, used for therapeutic purposes, is responsible for a non-negligible number of cases of poisoning, some fatal. We report a case of poisoning after cutaneous application of cade oil in a 2-month-old infant. The outcome was fatal. This report calls attention to the real possibility of this event and emphasizes the interest of preventing it by promoting information to families in Morocco.

Purulent pericarditis has become rare since the advent of antibiotics. Among the involved germs, S. pneumoniae remains the most implicated pathogen to evoke in principle, especially that prescription of systematic antibiotics for any febrile condition can considerably mask the clinical picture. A 36-year-old pregnant woman was visiting the emergency department for dyspnea and flu-like syndrom that had been going on for a week. The chest X-ray showed a white lung on the left and the transthoracic ultrasound revealed a pericardial effusion, resulting in pericardial drainage and pleural puncture that allows the evacuation of a purulent fluid. S. pneumoniae was identified on the pericardial fluid. Antibiotic therapy and resuscitation measures have allowed a good evolution. Even if it has become exceptional, pneumococcal pericarditis must not be overlooked since the evolution is often favorable in triple conditions: early recognition, prompt institution of appropriate antibiotic therapy, and early surgical drainage.

Neurological manifestations of preeclampsia are serious and very variable. We report the case of a woman at 34 weeks gestation with preeclampsia who developed blindness within hours without alteration of consciousness. The imagery was in favor of posterior reversible encephalopathy. The therapeutic management consisted of emergency fetal extraction, the administration of antihypertensive drugs and magnesium sulfate. The outcome was favorable with complete recovery of visual function. This case reflects the heterogeneity of the clinical presentation of preeclampsia, as the only neurological manifestation was cortical blindness, with no associated consciousness disorder.

Recent large use of magnesium in the obstetric population should incite anesthesiologists to control its side effects and drugs interactions. We report a case of a 30-year-old woman, with severe preeclampsia and HELLP syndrome, receiving sulfate magnesium and nicardipine, who underwent a cesarean section under general anesthesia. She developed a prolonged and deep neuromuscular blockade, which was antagonized three hours later with neostigmine. In case of therapeutic hypermagnesaemia, non-depolarizing relaxants must be used in reduced doses, and at increased time intervals, with appropriate neuromuscular monitoring., Competing Interests: The authors declare no conflicts of interest.

Background . Heart disease is the leading cause of nonobstetric mortality in pregnant women. Because of high risk, medical management represents the first line of treatment. However, when medical treatment fails, cardiac surgery becomes necessary. Case Presentation . A 27-year-old female who underwent successfully cardiac surgery three times within 3 years. At the first time, she had an aortic valve replacement at 25 weeks of gestation after an infectious endocarditis complicated with an ischemic stroke. At 39 weeks of gestation, she had delivered, vaginally, a healthy baby boy weighing 2800 g. In the second time, pregnant again at 30 weeks of gestation, she had a mitral valve replacement with an aortic prosthesis reinforcement after a paraprosthetic regurgitation and a mitral vegetation. A fetal death in utero had occurred; the extraction of the fetus by cesarean section with a tubal ligation was performed after stabilization of the mother. In the third time, she underwent successfully a mitral prosthesis replacement with Bentall's procedure after a mitral prosthesis disinsertion with an abscess of aortic annulus due to new episode of infectious endocarditis. Conclusion . Our patient has assembled almost all poor prognosis factors, which makes her a real historic case, probably never described in the literature.

Wernicke's encephalopathy is caused by severe thiamine deficiency; it is mostly observed in alcoholic patients. We report the case of a 28-year-old woman, at 17 weeks of gestational age, with severe hyperemesis gravidarum. She presented with disturbance of consciousness, nystagmus, ophthalmoplegia, and ataxia. The resonance magnetic imagery showed bilaterally symmetrical hyperintensities of thalamus and periaqueductal area. The case was managed with very large doses of thiamine. The diagnosis of Wernicke's encephalopathy was confirmed later by a low thiamine serum level. The patient was discharged home on day 46 with mild ataxia and persistent nystagmus. Wernicke's encephalopathy is a rare complication of hyperemesis gravidarum. It should be diagnosed as early as possible to prevent long-term neurological sequela or death. Thiamine supplementation in pregnant women with prolonged vomiting should be initiated, especially before parenteral dextrose infusion. Early thiamine replacement will reduce maternal morbidity and fetal loss rate.

Acute kidney injury (AKI) is a rare but life-threatening complication of pregnancy. The aim of this paper is to study the characteristics of acute AKI in pregnancy and to emphasize on its management modalities in Moroccan hospitals. This is a national prospective study performed over six months from July 1 to December 31 2010 on AKI developing in pregnant patients, both preand post-partum period. Patients with pre-existing kidney disease were excluded from the study. Outcome was considered unfavorable when complete recovery of renal function was not achieved and/or maternal death occurred. Forty-four patients were included in this study. They were 29.6 ± 6 years old and mostly illiterate (70.6%). Most AKI occurred in the post-partum period, with 66% of the cases occurring in those who did not receive antenatal care. The main etiologies were pre-eclampsia (28 cases), hemorrhagic shock (six cases) and septic events (five cases). We noted three cases of acute fatty liver, one case of obstructive kidney injury and one case of lupus nephritis. Hemodialysis was necessary in 17 (38.6%) cases. The outcome was favorable in 29 patients. The maternal mortality rate was 11.4%. Two poor prognostic factors were identified: Age over 38 years and sepsis. AKI is a severe complication of pregnancy in developing countries. Its prevention necessitates the improvement of the sanitary infrastructure and the establishment of the obligatory antenatal care.

Peganum harmala L. is a plant widely distributed in the Mediterranean region. It is commonly used in traditional medicine in Morocco as sedative and abortifacient but exposes users to the risk of overdose and poisoning. The pharmacologically active compounds of this plant include a number of β -carboline and quinazoline alkaloids responsible of its pharmacological and toxicological effects. We report the case of a 24-year-old woman, 22 weeks pregnant, intoxicated with the seeds of Peganum harmala L. On admission, she had disturbance of consciousness, uterine contraction, and oliguria. Laboratory tests revealed renal failure and liver injury, and she benefited then from hemodialysis. During hospitalization, she was intubated after deterioration of consciousness and presented a spontaneous expulsion of the fetus. After extubation, she kept unusual sequelae: cerebellar ataxia and peripheral polyneuropathy. Physicians in regions using Peganum harmala L. as traditional medicine must be able to detect symptoms of its toxicity, in order to establish early gastrointestinal decontamination. The prognosis of this intoxication is variable; most cases can be managed successfully; but in high doses of intoxication, evolution can be fatal.

Aims: The objective of our study is to describe the epidemiological, clinical, biological, and therapeutic aspects of snake bites in children in northern Morocco., Methods: This retrospective study reviewed files of all children admitted to the pediatric intensive care unit of the Hasssan II University Hospital in Fez from April 2011 through April 2013. It includes all children reported by themselves or their family to have been bitten by a snake and all those with traces of snake fangs., Results: This study included 12 children, with a mean age of 9.6 ± 2.9 years. In each case, admission took place the day the envenomation occurred, a mean of 8.8 ± 5.6 hours after the bite. Locoregional signs and edema were seen in all cases, associated with bruising (58%) and blisters (25%). General events, including gastrointestinal, cardiovascular, neurologic, and hemorrhagic signs, affected 83% of the children. Hemostasis disorders occurred in 91% of patients, including profound thrombocytopenia (mean: 27.7 ± 30.7 G/L. All envenomations were grade 2 or grade 3. Analgesia was administered systematically; a fasciotomy was performed in 25% of cases and transfusion of blood products in 66%. Three children (25%) were intubated and two children died (16%)., Conclusion: This series is characterized by the severity of the clinical presentations, with a predominance of locoregional complications and hemostasis disorders corresponding to snake-bite syndrome. We conclude that immunotherapy adapted to the local species must be made available to improve the prognosis of this envenomation.

Patient: Female, 14 FINAL DIAGNOSIS: Postobstructive pulmonary edenma Symptoms: Chest indrawing • bilateral pulmonary crepitations • tachypnea, Medication: - Clinical Procedure: Controlled ventilatory support • positive end expiratory pressure Specialty: Intensive care., Objective: Unusual clinical course., Background: Postobstructive pulmonary edema (POPE) is a life-threatening complication that occurs after the relief of an upper airway obstruction. POPE occurs rarely in children, primarily after non-lethal hanging., Case Report: We report the case of a 14-year-old girl who developed POPE after accidental near hanging. She had chest in-drawing, the SpO2 was 81% on room air, and pulmonary auscultation revealed bilateral crepitations. The chest x-ray showed bilateral diffuse infiltrates consistent with pulmonary edema. The intensive care management consisted of controlled ventilatory support with high-level positive end expiratory pressure. On the third day of hospitalization, the patient was weaned from the ventilator and extubated with a full recovery., Conclusions: This case confirms the importance of early recognition of POPE and the value of adapted treatment, which can lead to a favorable outcome and full recovery in cases of near hanging.

The finding of a double-chambered right ventricle (DCRV) is exceptionally rare as an isolated anomaly. It is a congenital cardiac anomaly in which the right ventricle is separated into two chambers, a proximal high-pressure chamber and a distal low-pressure chamber, by anomalous muscles or fibrous tissues in the right ventricular cavity. We report the case of a 6-year-old infant who was admitted for growth retardation. The patient was diagnosed with an isolated DCRV without any other associated congenital anomalies. The patient underwent a successful cardiac surgical procedure of enlargement repair; he was discharged in good clinical condition with a normal cardiac function.

This case report refers to a 21-year-old primigravida, who complained of dyspnoea and was noticed to have unusual swelling of the face and neck after home delivery. A diagnosis of subcutaneous emphysema was made and this was confirmed with the chest X-ray. Pneumomediastinum and hydropneumothorax were also detected. Uneventful recovery over three days followed conservative management., (Copyright © 2012 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.)

Indigo, also known in Morocco as Nila, is a dye widely used in the coloring of Moroccan handicrafts. It is obtained from fermentation reactions on the leaves and branches of true indigo, Indigofera tinctoria, which is a widespread plant in tropical Africa and Asia. We report a case of fatal poisoning in a 3-year-old child after administration of indigo for therapeutic purposes. Death resulted from multiple organ failure. The toxicity of this compound is little known in the literature and deserves to be explored through toxicokinetic and toxicodynamic studies, in order to better determine the toxic constituents of the dye., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Atropa belladonna is a poisonous plant also called deadly nightshade. Its roots, leaves and fruits contain alkaloids: atropine, hyocyamine and scopolamine. The risk of poisoning in children is important because of possible confusion with other berries. Atropa belladonna acute intoxication is a severe condition, it's should be considered in the presence of anti-cholinergic toxidrome, the differential diagnosis include other plants or psychoactive drugs containing atropine. The treatment is mainly symptomatic including gastrointestinal decontamination with activated charcoal. In severe cases, physostigmine can be used as an antidote. We report the case of 11 year old girl with Atropa belladonna poisoning which was administrated in a therapeutic purpose as a remedy to jaundice. The child presented essentially a central anti-cholinergic syndrome. She was admitted in the intensive care unit, the progression was favorable with symptomatic treatment.

CANTRELL SYNDROME IS A VERY RARE CONGENITAL DISEASE ASSOCIATING FIVE FEATURES: a midline, upper abdominal wall disorder, lower sternal abnormality, anterior diaphragmatic defect, diaphragmatic pericardial abnormality, and congenital abnormalities of the heart. In this paper, we report a case of partial Cantrell's syndrome with left ventricular diverticulum, triatrial situs solitus, ventricular septal defect, dextrorotation of the heart, an anterior pericardial diaphragmatic defect, and a midline supraumbilical abdominal wall defect with umbilical hernia. The 5-month-old patient underwent a successful cardiac surgical procedure. A PTFE membrane was placed on the apex of the heart to facilitate reopening of the patient's chest. Postoperative course was uneventful. The patient was discharged with good clinical condition and with a normal cardiac function.

Congenital Insensitivity to pain with anhydrosis (CIPA) is a rare inherited disease. It is classified as hereditary sensory and autonomic neuropathy type IV. Pain insensitivity and autonomic deficits are present, but touch and pressure sensitivity are unimpaired. Mental retardation is usually present. We report a family case of a 5 years old girl and 2 years old boy with congenital insensitivity to pain, while discussing the clinical features and the anesthetic strategy of such patients. Patients with Congenital Insensitivity to Pain with anhydrosis may undergo surgery because of susceptibility to trauma due to absence of pain. The clinical features may intrinsically possess anesthetic challenges.

Dislocation of temporo-mandibular joint (TMJ) is an infrequent disease but still spectacular. This disease consists of a permanent, to some extent complete disruption of the temporo-mandibular joint. These dislocations often occur in a context of yawning, and less frequently after a burst of laughing or relatively mild facial trauma (slap, punch on the chin). We report a case of TMJ occurring in an uncommon circumstance: vaginal delivery. A woman aged 24-years with no special past medical history; primipara was admitted in the Department of Maternity of the University Hospital Hassan II of Fez for an imminent delivery of a twin pregnancy. Ten minutes after admission, the patient delivered vaginally with episiotomy. She gave birth to twins weighing 2800 g and 2400 g. During labour, and due to efforts of crying, the patient developed a sudden and immediate loss of function of the temporo-mandibular joint, with difficulty of speaking, the mouth permanently opened and with the chin lowered and thrown forward. The examination found an empty glenoid fossa of the temporo-mandibular joint in both sides. The diagnosis of dislocation of the TMJ was established. A CT scan of facial bones was done, objectifying a bilateral dislocation of TMJ. The reduction of this dislocation was performed in the operating room under sedation.