Search

Since December 2019, the coronavirus disease (COVID-19) pandemic has catapulted the world into a marked health crisis, with over 29 million cases and >930,000 deaths. To better detect affected individuals at an early stage and stop disease progression to an advanced stage, several studies have been conducted to identify the clinical, biological, and radiological characteristics of COVID-19. This study aimed to enrich the literature by critically analyzing the clinical and biological characteristics of 134 patients from the North African Mediterranean region, including numerous genetic, epigenetic, and environmental factors that may influence disease evolution. This single-center retrospective study included all patients older than 18 years confirmed to have COVID-19 and hospitalized at the Cheikh Khalifa University Hospital affiliated with Mohammed VI University of Health Sciences, Casablanca, Morocco. Clinical, demographic, and biological data were analyzed in a cohort of severe and non-severe patients. Univariate analysis was performed to identify factors predictive of severity. There were 134 patients: the median age was 53 years, and 54.5% were male. Of these, 89 had mild to moderate disease; 45 had severe to critical disease, of which 14 died and 31 survived. Advanced age, presence of comorbidities, male sex, and infection in ethnic or family groups were risk factors for progression to severe disease. The presence of abnormalities in the following parameters were strongly associated with progression to severe disease: white blood cells (WBC), neutrophils, lymphocytes, C-reactive protein (CRP), procalcitonin, D-dimers, lactate dehydrogenase (LDH), ferritin, creatinine, aspartate aminotransferase (ASAT), and alanine aminotransferase (ALAT) during both admission and hospitalization. Based on these results and an extensive literature review, we recommend that clinicians closely monitor the biological parameters identified herein and perform immunological and genetic studies.

Les abcès froids de la paroi thoracique représentent une forme rare et inhabituelle de tuberculose extrapulmonaire. Sa fréquence est estimée à moins de 5% des tuberculoses ostéoarticulaires, évaluées elles-mêmes à 15% des tuberculoses extrapulmonaires. L'objectif de ce travail est de rapporter la prise en charge diagnostique et thérapeutique de cette localisation dans notre structure. Etude rétrospective portant sur 18 cas colligés au service des maladies respiratoires du centre hospitalier universitaire Ibn Rochd de Casablanca, sur une période de 13 ans. La moyenne d'âge était de 34 ans (21-57). Un antécédent de tuberculose traitée était relevé dans un cas. Le tableau clinique était révélé par l'apparition insidieuse d'une masse pariétale de taille, de consistance et de siège variables. A l'imagerie thoracique, l'abcès pariétal était associé à une lyse osseuse dans sept cas, une atteinte parenchymateuse et pleurale dans quatre cas chacune et des adénopathies médiastinales dans deux cas. La confirmation diagnostique était bactériologique et/ou histologique dans tous les cas. La sérologie du virus de l'immunodéficience humaineétait négative chez tous nos malades. L'évolution sous traitement antibacillaire couplé ou non à une résection chirurgicale était favorable chez tous nos malades. Malgré la fréquence de la tuberculose dans notre contexte, la localisation pariétale thoracique reste rare, survenant chez une population non immunodéprimée et non toxicomane, contrairement à ce qui est souvent rapporté dans la littérature. Les abcès froids tuberculeux représentent une forme rare de tuberculose extrapulmonaire dont l'évolution reste favorable sous traitement précoce et bien conduit.

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.

L'inhalation d'un corps étranger (CE) est une urgence médicale courante dans tous les âges. Chez l'adulte, cet accident est beaucoup plus rare que chez l'enfant et survient le plus souvent sur des terrains prédisposés. L'objectif est d’évaluer l'approche diagnostique et thérapeutique de l'inhalation endobronchique d'un CE chez l'adulte. Nous rapportons une étude rétrospective réalisée sur une période de plus de 20 ans (entre Janvier 1994 et Mai 2014) concernant 51 cas de CE endobronchiques de l'adulte. Leur mode de révélation, leurs caractéristiques cliniques, radiologiques et évolutives, la nature de ces CE inhalés sont décrits. Il s'agissait de 8 hommes et 43 femmes dont l’âge moyen était de 28 ans. Un terrain prédisposant est noté dans 13 cas. Le syndrome de pénétration était le maitre symptôme révélateur, retrouvé dans 46 cas. Le siège du CE était bronchique droit dans 30 cas. L'extraction est réalisée par bronchoscopie souple dans 40 cas, rigide dans 3 cas et par chirurgie dans 4 cas. Quatre patientes ont rejeté spontanément le corps étranger. La nature du CE était variable mais restait largement dominée par les épingles à foulards. Nous insistons sur la rareté et la gravité potentielle de l'inhalation de CE qui reste dominée dans notre contexte culturel par l’épingle à foulard chez les jeunes filles. En dehors d'un syndrome de pénétration évident, le diagnostic est souvent difficile faisant recours à la bronchoscopie à la fois diagnostique et thérapeutique. Les mesures préventives restent le meilleur traitement.

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.

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.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.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%).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.

The occurrence of invasive pulmonary aspergillosis is unusual during the course of AIDS. Patients at risk have a CD4 T-lymphocyte count under 50 cells/mm(3) combined with other risk factors in 50% of the cases. Positive diagnosis is based on chest CT scan imaging and isolation of Aspergillus in broncho-alveolar fluid. Detection of galactomannan antigen in serum and broncho-alveolar lavage fluid (BALF) is a reliable complementary tool in assessing the diagnosis. The first line therapy is Voriconazole. The prognosis, often severe, depends on prompt initiation of the appropriate antifungal treatment. We report two cases of invasive pulmonary aspergillosis in AIDS patients.

Multiple lung hydatidosis associated with cardiac localization is rare, whereas large arterial localization is exceptional and involves a poor prognosis. The authors report the case of a 26-year-old man living in a rural area, without a past medical history. He presented chest pain, hydatidoptysis and syncope. A chest x-ray revealed multiple bilateral cysts. A chest CT scan detected multiple cysts in the heart, the pericardium and multiple pulmonary cysts. Echocardiography revealed cysts in the right and left auricle, the pulmonary artery as well as the pericardium. Medical three treatments were administered before surgical intervention on the heart cysts under extracorporeal circulation, revealing an enormous hydatid cyst at the beginning of the aorta. Unfortunately, the patient died during the immediate postoperative phase.

Multiple thoracic hydatic disease involving a cardiac and pulmonary localization is exceptional and prognosis is poor. We report a case in a 21-year-old male who presented repeated episodes of hemoptysis. The chest x-ray showed multiple opacities. The thoracic computed tomography and echocardiography visualized cystic formations in the heart and the pulmonary arteries. Hydatic serology was strongly positive. Medical treatment with albendazole was given but the patient died from massive hemoptysis before the cardiac and pulmonary artery cysts could be removed surgically (a procedure which requires extracorporeal circulation). A hydatic cyst of the pulmonary artery is usually secondary to a cardiac localization. The risk is dissemination into the pulmonary and eventually systemic circulation. An arterial localization must be carefully ruled out in all patients with multiple or cardiac hydatidosis. Treatment is surgical to avoid dissemination.

Paraganglioma is rare tumor arising from chromaffine cells. We report a 39-year-old man who was diagnosed with anterior mediastinal paraganglioma. Computed tomography (CT) revealed a solid mass in the anterior mediastinum. Surgical biopsies obtained by sternotomy confirmed histologic and immunohistochemical features of paraganglioma. Surgical removal of this vascularized and invasive tumor was not possible to. External radiotherapy was performed. Three years later, the patient developed chest pain. CT findings showed right nodular pleural masses. Transparietal biopsy confirmed the same pathological aspect of paraganglioma. Chemotherapy was proposed without significant response. This observation confirmed the rare course of paraganglioma to pleural metastases. Treatment of paraganglioma is mainly surgery if the mass is resectable.

Pleuropulmonary involvement is the second most common extra-intestinal manifestation of entamoeba histolytica infection after liver abscess.We report 2 cases of pleuropulmonary disease occurring in two men aged 32 and 48 years following an episode of dysentery. Purulent pleural infection was noted in one case. In the other both lung and liver abscesses occurred.The diagnosis was confirmed by strongly positive serology in both cases. Treatment with metronidazole (1.5 g per day) for 15 days combined with pleural drainage led to a satisfactory outcome in both cases.

Hydatic cyst of the liver remains a serious public health problem in Morocco and several other Mediterranean countries. This benign affection can cause serious sometimes fatal complications such as cyst rupture into the biliary ducts or the thorax. We present the case of a patient with serofibrous pleurisy and recall the often late diagnosis of hydatic cyst. Biliary pleural fistulization is a rare but serious complication.

Parietal thoracic abscess formation of a tuberculous nature is a rare form of extrapulmonary tuberculosis, usually described in cases of severe tuberculosis encountered in HIV-infected patients. We report 13 cases of parietal tuberculosis in patients without HIV infection who were investigated between October 1988 and December 1999. During this period, we cared for 2 663 patients with tuberculosis. The series included 9 women and 4 men age 17 to 60 years, mean age 39 years. The clinical aspect of the parietal abscess was variable. Cold fluctuating abscess was dominant in 10 cases. In 3 cases, the parietal abscess had a hard consistence simulating a malignant tumor. The parietal abscess was in a posteriosuperior or posteriobasal location in 4 cases, and in an anterosuperior, anterobasal or axillary location in 6. Multiple thoracic abscesses were observed in only 3 cases. The size of the abscess varied from 2 to 2.5 cm. Radiologically, rib damage was present in 4 cases, scapular damage in 1, with bone lysis in 3 cases. Other localizations of tuberculosis were observed in 4 cases. one patient had multiple peripheral node enlargement, another had parenchymal lung damage and a third had a vertebral localization. Culture of abscess pus provided the diagnosis in 10 cases. the diagnosis was confirmed by pathology in 8 cases on a biopsy of the abscess border. Anti-tuberculosis drugs allowed successful recovery in all patients. We analyzed the clinical aspects of cold thoracic abscesses and discuss differential diagnosis. Early diagnosis and treatment is essential.

Multiple hydatidosis in a thoracic localization is unusual and a cardiac localization very exceptional. We report a case of multiple hydatidosis greatly improved by medical treatment with albendazole which was associated with a cardiac cyst successfully treated by surgical resection. No recurrence has been observed at 4 year follow-p. We point out therapeutic management options in these unusual forms of the disease.

The authors reported a case of Hodgkin disease with excavated lung localisation discovered during a systematic detection in the occupational medicine framework. This observation raised the differential diagnosis problems mainly with tuberculosis in endemic countries.

On account of the increased use of rubber gloves, latex allergy is a current problem. The problem can present as anaphylaxis revealing its serious nature. The aim of this study was to evaluate the prevalence of sensitivity to latex in health personnel. We carried out an enquiry on the hospital staff in Casablanca (Hospital of the 20th of August, Childrens Hospital, the Dental Centre, the Bouafi Hospital and Sidi Otmane Hospital). This study involved 600 subjects; 408 women and 192 men. The population was composed of 273 nurses of either sex, 169 doctors and 104 care workers and 54 administrators. The study was carried out using an anonymous questionnaire and cutaneous prick tests looking for latex allergy and atopy. Thirty two subjects (5.3%) showed a positive prick test to latex. There were 19 nurses, nine doctors, two health workers and two administrators. A study of specific immunoglobulins to latex carried out in 15 cases was positive in four. In the population with a positive prick test an alimentary allergy was identified in nine cases. The prevalence of atopy in the subjects allergic to latex (81%) was greater than in the latex negative population (16%). After seeing the frequency of latex allergy in hospital personnel we believe that a replacement of other types of gloves (e.g. vinyl) would probably be preferable for all tasks where latex is not indispensable.

A 27-year-old man with an uneventful history was hospitalized after fortuitous discovery of an opacity in the right lung field. The clinical examination revealed a multi-nodular euthyroidian goiter. Laboratory tests, including blood glucose, were normal. Computed tomography of the chest showed a pleural formation and associated pleural effusion. Complete surgical exeresis led to the diagnosis of benign fibrous pleural mesothelioma. Fibromas of the pleura are rare and usually discovered due to extra thoracic signs. The clinical course is long and often silent. Surgical removal is indicated and usually is complete.

The aim of this work is to determine the clinical characteristics of haemoptysis and their principal aetiologies in a retrospective study of 291 cases collected over 5 years and occurring in adults who were hospitalised in a pneumology service. The annual incidence of haemoptysis was 8.8% of the in-patient population. The mean age of the patients was 46 and 47% were less than 50. The males were most frequent (69.4%) and haemoptysis was the presenting feature in 35.4%; it was minimal in 71.1% of average quantity in 26.8% and severe in 2.1%. The thoracic radiograph was judged abnormal in all cases and the abnormalities noted were suggestive of a particular aetiology in 70.8% of cases. The aetiological cause was dominated by bronchial cancer and of active pulmonary tuberculosis or its sequalae with levels of 34.4% and 18.9% respectively. For the other causes bronchial dilatation was important with 15.1% and hydatic cysts another 9.3%. Other aetiologies were represented by bacterial pneumonias with or without abscesses 7.2%, pulmonary aspergilloma 6.9%, chronic bronchitis with or without emphysema 3.5% and by rare causes in 4 cases. The cause for the haemoptysis was not found in 3.1%. This study brings out the preponderant place of bronchial cancer as a cause of haemoptysis in a country which still has a high prevalence of tuberculosis. Nevertheless the existence of tuberculosis services where the greater part of tuberculosis patients are hospitalised explains in part the predominance of bronchial cancer increasing very rapidly in our service.

Two mini-peak flow meters, the Airmed (mini-Wright) and the Medicheck (Pulmonary Monitor), were assessed against a reference electronic spirometer (Spiromatic, based on a pneumotachograph, integrator and an Apple II computer) in a series of 10 healthy subjects and 20 patients with chronic obstructive lung disease. The devices to be tested were mounted in series with the reference instrument; each subject did five trials. It was found that the Airmed instrument overestimated the flows up to 9 l X s-1 (i.e. in patients, average difference 0.86 l X s-1, p less than 0.001; in healthy subjects, average difference 0.35 l X s-1, p less than 0.001). The correlation with the results of the reference instrument was high (r = 0.992) in healthy subjects, whose regression slope was less than unity (0.763). In patients the correlation was satisfactory (r = 0.974), and the slope close to 1 (1.05). The Medicheck overestimated slightly the results of patients (difference 0.17 l X s-1, p less than 0.01); in normal subjects the overestimation was present only below 10 l X s-1 and the difference with the reference instrument nonsignificant (average 0.19 l X s-1). The results were closely related to those of the reference spirometer in both healthy subjects (r = 0.960) and patients (r = 0.936). As for the first instrument the slope of the regression was below 1 in healthy subjects (0.751) and practically one (1.01) in patients.(ABSTRACT TRUNCATED AT 250 WORDS)