Intérêt pronostique du dosage de la troponine hyper-sensible dans la pré-éclampsie

Background:Pre-eclampsia is a pregnancy complication leading to significant morbidity and mortality. High-sensitivity troponin (hs-cTnI ) is one of the most sensitive cardiac biomarkers, but its variation in preeclampsia remains poorly studied. The aim of our study was to assess the prognostic value of hyper-sensitive troponin in preeclampsia. Methods:It was a prospective study including patients with preeclampsia. The exclusion criteria included conditions that may cause an elevation of hs-cTnI. Preoperative laboratory assessment included the determination of the level of hs-cTnI. The discriminative value of the preoperative hs-cTnI allowing to predict the onset of complications was evaluated by the ROC curve. Group A included patients whose rate was above the calculated cutoff, and group B included the others Results:Seventy seven patients were included. Complications occurred in 22% of cases. The preoperative hs-cTnI cutoff of 6.3 ng/l predicted the onset of complications (sensitivity 70.6% / specificity 86.6% / p <0.0001). There was a higher rate of severe pre-eclampsia and complications, a higher systolic and mean arterial blood pressure values in group A with significant differences. Both groups were comparable demographically, obstetrically, clinically and biologically. Conclusion :According to the results of our study, increased values of preoperative hs-cTnI may predict the onset of complications in pregnancies complicated by preeclampsia.     

Severe hypercalcemia complicated by acute pancreatitis revealing generalized bone lysis metastasis: Case report and review

Malignant hypercalcemia is a frequent metabolic complication of osteophilic tumors, exceptionally revealing cavitary cancer, but its prognosis remains poor despite early and adequate management. We report the case of a young patient, smoker without any previous history, admitted for the management of a digestive symptoms made of abdominal pain with food vomiting. The patient had an electrocardiogram withchest computed tomography scan and BBC evoking PA on malignant hypercalcemia. An etiological investigation was conducted to confirm the tumoral origin of the hypercalcemia. We put the patient on hyperhydration with corticotherapie and biohosphonates with a good clinical and biological improvement. Malignant hypercalcemia affects about 10%-20% of patients with cancer including nasopharyngeal carcinoma. Its clinical presentation varies according to the extent and speed of onset, responsible for multivisceral involvement including kidney, heart, neuropsychiatric system, which may engage the patient''s vital prognosis. The therapeutic management is based on 4 main principles; hyperhydration, increase of urinary calcium excretion by loop diuretics, decrease of bone resorption by biphosphonates and extrarenal purification which remains the ideal choice in case of life-threatening severe hypercalcemia. Acute hypercalcemic pancreatitis as a mode of revelation of cavum cancer has almost never been described in the literature     

Unusual facial lesions in H syndrome

H Syndrome is a rare genodermatosis. It may include facial involvement such as: facial telangiectasia, both hypo‐ and hyperpigmented lesions, hirsutism, swollen cheeks due to subcutaneous infiltration and eczematous lesions. We describe a new facial phenotype with dermoscopic and histological features in the spectrum of non‐Langerhans cell histiocytosis.     

Orbital inflammatory pseudotumor revealing multi-organ immunoglobulin G4-related disease

Relatively recently, the concept that immunoglobulin G4 (IgG4)-related disease is a distinct chronic inflammatory disorder rather than a subset of Sjögren's syndrome has been accepted. IgG4-related disease (IgG4-RD) is a fibro-inflammatory systemic immune-mediated condition that can affect the pancreas, salivary glands, and lymph nodes. Almost every organ may be impacted synchronously or metachronously by this illness, which causes the development of sclerotic masses of varying sizes. Numerous other rheumatic diseases can present with characteristics of IgG4-RD, making it difficult to distinguish between them. However, cases of IgG4-RD involving the bilateral orbits, and pancreas with biological abnormalities are rare. We present a case of an 18-year-old female with vitiligo since the age of 3 years who presented with acute pancreatitis and acalculous cholecystitis, bilateral orbital masses, palpebral edema, and eosinophilia. The patient was diagnosed with IgG4-RD in keeping with clinical presentation and the elevated serum IgG4 level and after elimination of other differential diagnoses. The patient's symptoms gradually relieved after glucocorticoid therapy. This case presents an uncommon combination of clinical features infrequently reported in the literature. Multi-organ IgG4-RD is a multisystemic mass, commonly creating diagnostic challenges for clinicians. Furthermore, and more importantly, it highlights the need to keep a differential of IgG4-RD in mind, to aid in the early and correct treatment of the disease.