H. Sajiai

L’accès psychotique aigu secondaire à la prise d’isoniazide

INTRODUCTION Acute psychotic access is defined as the occurrence of a single, acute, and intense psychotic episode in a subject without a neurological or psychiatric history. Isoniazid (INH), a major antibacillar, is the drug most often involved in the occurrence of this psychiatric disorder. However, this side effect is rare and only a few cases have been reported in the literature. CASE REPORT A 57-year-old female patient with diabetes mellitus presented miliary tuberculosis for which an antibacillar treatment was prescribed. Three days later, she presented an acute psychotic access requiring the withdrawal of the INH and the prescription of neuroleptic drugs, without any pyridoxine supplementation. The lab tests were normal. The good clinical evolution after the INH withdrawal confirmed its imputabilty. CONCLUSION Acute psychotic access is a severe and exceptional complication following the administration of INH. Emergency treatment is the only guarantee of a good outcome.

Flexible bronchoscopic removal of a fractured metallic tracheostomy tube.

Patients frequently require a tracheostomy for a variety of indications, but its prolonged use is associated with several complications, including fracture of the tube. Metallic tracheostomy tubes, which are often used in developing countries, are predisposed to such a complication essentially because of corrosion from prolonged used. We report 2 cases of a fractured tracheostomy tube inserted into the central airways, with different clinical presentations. Fractured pieces were successfully removed using a flexible bronchoscope under topical anesthesia.

Sténose trachéale révélant un lupus érythémateux systémique

Systemic Lupus Erythematosus (SLE) with respiratory involvement is less well known than cutaneous, articular and renal involvement. Clinical course is quite variable and dominated by pleural involvements. Tracheal stenosis is unusual, if not exceptional in patients with this disease. We here report a quite particular case of systemic lupus erythematosus revealed by tracheal stenosis with dry eye-buccal syndrome.

Endobronchial localization of Hodgkin's disease

The endobronchial localization of Hodgkins disease is a rare entity which is often confused with endobronchial tuberculosis in our setting. We report the case of a 16 years old female who presented with 6 months history of dry cough, hemoptysis, dyspnea, dysphagia and dysphonia. The chest radiography showed a mediastinal and pulmonary opacity. The chest CT scan found enlarged mediastinal lymph nodes. The bronchial biopsy and peripheral lymph node biopsy confirmed Hodgkins disease with endobronchial localization. The patient received chemotherapy (ABVD protocol) and radiotherapy with a favorable follow up.

Prévalence du tabagisme chez le personnel médical et paramédical du CHU Mohamed VI à Marrakech

Smoking is a major public health problem. Doctors and paramedical staff are not excluded from this plague. Smoking ban in hospitals originated from government effort to reduce passive smoking. The objectives were to evaluate smoking habits among doctors and paramedical staff in order to implement tobacco control strategy in this study population and to refer them to the smoking-cessation counselling. We conducted a descriptive cross-sectional study of the entire staff of the Hospital University Center Mohammed VI, Marrakech based on the distribution of anonymous questionnaires. A total of 530 questionnaires were distributed, and 380 were returned, a response rate of 71.7%. The study population consisted of 58.2% women (n=221) and 41.8% men (n=159). Doctors (n=220) were the most represented occupational category (57.9%) followed by nurses (31.8%). Smokers (n=62) accounted for 16.3% of our study population; the ex-smokers (n=31) accounted for 8.1% and the non-smokers (n=287) 75.5%. The average age of smokers was 31.1 years, ranging from 22 to 56 years. The prevalence of smoking was 16.3% (n=62) of study population, of whom 32.7% (n=52) among men compared to 4.5% (n=10) among women. The average age of smoking onset was 19 years with a range from 11 to 29 years and with a mean consumption of 9 cigarettes/day. 13% (n=50) of people even smoked narguilé, 9% (n=34) consumed alcohol, and 3% (n=21) cannabis. 67.7% of smokers (n=42) were planning to quit, of whom 30.9% (n=13) in the next 3 months, 52.4% (n=22) in the next 6 months and 16, 7% (n=16) were planning to quit in the year. Several activities encouraged smoking, including night shift, coffee breaks and meals in 90.3% (n=56), 64.3% (n=40) and 61.3% (n=38) of cases respectively. This survey highlights the need to carry out awareness-raising actions to strengthen people motivation to quit smoking and help them during their withdrawal.

Hydatidose multiple à localisation inhabituelle, pancréatique et pelvienne : à propos d’un cas

Hydatid cyst is an infectious disease which is quite frequent in Morocco. Pelvic and pancreatic locations of this parasitic infection are rare, namely exceptional. We report the case of a 66-year old patient who was operated for liver hydatic cyst 6 years before, presenting for chest pain associated with hydatidoptysis. Chest X-ray objectified left hydropneumothorax. Thoraco-abdominopelvic CT showed mediastinal liquid mass as well as multiple hepatic, pancreatic (isthmus), pelvic and left under diaphragmatic cystic lesions. Hydatid serology was positive. Treatment involved thoracotomy associated with medical treatment.

Prevalence of Skin Sensitization to Pollen of Date Palm in Marrakesh, Morocco

Background. Date palms pollen has been identified as a source of allergy; the rate of sensitization of this pollen is between 6 and 29%. Objective. To determine the prevalence of sensitization to date palm in Marrakesh and to identify the clinical profile. Patients and Methods. This study is based on a questionnaire and the prick test on 7 allergens, in population aged 5 years and above with clinical symptoms suggesting allergic diseases, from November 2012 to February 2013 in Marrakech. Results. We included 468 patients (women: 79.5%). The prick tests were considered interpretable in 467 cases. The prevalence of skin sensitization to pollen of date palm was 6.6%. The 31 cases of sensitization to date palm involved 7 men and 24 women with an average age of 37.5 years. Cutaneous monosensitization to date palms pollen was observed in 2 cases. Asthma, rhinitis, and conjunctivitis were recorded, respectively, in 48.4%, 93.5%, and 67.7%. Conclusion. Skin sensitization to pollen of date palm does not seem unusual among allergic patients in Marrakech and is comparable to that found in Casablanca (7%), Barcelona (6.6%), and Cartagena (6.1%).

Histiocytose langerhansienne pulmonaire révélée par un pneumothorax: à propos d’un cas

L’histiocytose langerhansienne est une affection rare d’étiologie inconnue caractérisée par une infiltration d’un ou plusieurs organes, par des cellules de type Langerhans. Elle a une présentation clinique polymorphe. Nous rapportons le cas de Mr R.Y, âgé de 22 ans, tabagique à 8 PA, admis pour pneumothorax total spontané droit. Un drainage thoracique a été réalisé avec bonne évolution. La TDM thoracique de contrôle a objectivé de multiples formations kystiques diffuses prédominant aux lobes supérieurs. Un bilan a été réalisé à la recherche d’une histiocytose systémique mais s’est révélé négatif. L’évolution était marquée par la récidive du pneumothorax, le recours à une pleurodèse et la réalisation d’une biopsie pulmonaire qui a confirmé le diagnostic. Le diagnostic de l’HistiocytoseLangerhansienne doit être évoqué devant un pneumothorax sur poumon kystique. Le diagnostic est aisé devant un tableau clinique et radiologique évocateur. Néanmoins, les possibilités thérapeutiques restent limitées et la récidive du pneumothorax est fréquente.

Kyste hydatique pulmonaire: double localisation pulmonaire apicale inhabituelle: à propos d’un cas

Le kyste hydatique (KH) est une pathologie encore endémique dans plusieurs pays notamment dans notre contexte marocain. L’atteinte pulmonaire vient au second plan après l’atteinte hépatique. Elle se caractérise par la richesse des tableaux anotomo-cliniques et la possibilité de localisations multiples dans le parenchyme pulmonaire, prédominant essentiellement aux bases. Nous rapportons le cas de Mr J.M, âgé de 54 ans, admis pour suspicion de kyste hydatique pulmonaire devant une douleur thoracique évoluant depuis 6 mois et un épisode d’hydatidoptysie. La radiographie thoracique a objectivé une image particulière de double localisation apicale illustrant en un même cliché des différents stades évolutifs du kyste hydatique pulmonaire. Le diagnostic était confirmé par la TDM thoracique et la sérologie hydatique. La localisation multiple du kyste hydatique pulmonaire n’est pas une situation rare dans les pays à forte endémie hydatique. Notre cas clinique rapporte une double localisation apicale inhabituelle du kyste hydatique et à des stades évolutifs différents.

Lung Cancer in Women

At the same smoking level, women have a higher risk of lung cancer. The aim of the study was to evaluate epidemiological, clinical and histological profile of women’s lung cancer. A retrospective study including women patients with a confirmed lung cancer followed at the Pneumology Department of University Hospital Center Mohammed VI of Marrakesh in Morocco between January 2010 and December 2014. 14 cases were included in the study. The average age of patients was 54.2 years. Active smoking was noted in 2 patients (14.4%). The chest X-ray showed an atelectasis in 6 cases (42.8%), hilar opacity in 6 cases (42.8%) and alveolar opacity in 2 cases (14.4%), pleural effusion was present in 3 cases (21.4%). Histological confirmation was obtained in 10 cases (71.4%) by bronchial biopsy, 2 cases with pleural biopsy (14.4%), one case (7.1%) by lymph node biopsy and one case trans-parietal biopsy (7.1%). An adenocarcinoma was found in 9 cases (64.3%), squamous cell carcinoma in 4 cases (28.6%) and small cell carcinoma in one case (7.14%). The study shows that the lung cancer in women in our context occurs more often in non-smoker patients and it’s usually an adenocarcinoma type.