John Goldman Fellowships for Future Science

The level of circulating platelet‐, erythrocyte‐, leucocyte‐ and endothelial‐derived microparticles detected by high‐sensitivity flow cytometry was investigated in 37 β‐thalassaemia major patients receiving a regular transfusion regimen. The phospholipid procoagulant potential of the circulating microparticles and the microparticle‐dependent tissue factor activity were evaluated. A high level of circulating erythrocyte‐ and platelet‐microparticles was found. In contrast, the number of endothelial microparticles was within the normal range. Platelet microparticles were significantly higher in splenectomized than in non‐splenectomized patients, independent of platelet count (P < 0·001). Multivariate analysis indicated that phospholipid‐dependent procoagulant activity was influenced by both splenectomy (P = 0·001) and platelet microparticle level (P < 0·001). Erythrocyte microparticles were not related to splenectomy, appear to be devoid of proper procoagulant activity and no relationship between their production and haemolysis, dyserythropoiesis or oxidative stress markers could be established. Intra‐microparticle labelling with anti‐HbF antibodies showed that they originate only partially (median of 28%) from thalassaemic erythropoiesis. In conclusion, when β‐thalassaemia major patients are intensively transfused, the procoagulant activity associated with thalassaemic erythrocyte microparticles is probably diluted by transfusions. In contrast, platelet microparticles, being both more elevated and more procoagulant, especially after splenectomy, may contribute to the residual thrombotic risk reported in splenectomized multi‐transfused β‐thalassaemia major patients.     

Epidemiological, therapeutic and evolutionary profiles in patients with lymph node tuberculosis

Tuberculosis remains a public health concern worldwide particularly in Third World countries. Lymph node (LN) tuberculosis is the most frequent extra lung localization. Because of modern transport and mass migration from the developing to the developed world, it is important for all clinicians to keep this diagnostic possibility in mind. Evaluate demographic characteristics, diagnosis approaches, therapeutic strategies and evolutionary aspects while treatment in patients with confirmed LN tuberculosis. Data were retrospectively analyzed in 69 patients collected in 2 health centers in Rabat over a period of 4 years. There was a female (70%) and a young age predominance of patients (31.4 year +/-13.1). The median duration between the onset of symptoms and diagnosis was long: 115 days (interquartile range 34-150 days) explicated by low Socioeconomic conditions (p< 0.05). The cervical LN were most frequently involved (85.5%). The confirmation was histological in 98.5%, bacterial in the liquid from puncture LN in 1.5% of cases. 48% of patients had received treatment according to the national guide of tuberculosis. Half of the patients had received prolonged treatment on average of 7 months and a half (7.3 month +/-1.3) because of the paradoxical response (PR) (p< 0.05). At the end of treatment, LN had returned to their normal size in 80% of patients, we noted residual nodes in 11.6%, and a scrofula in 8.6%. The delay of diagnosis of LN tuberculosis is still important, and the treatment is prolonged because of PR.     

A case of rheumatoid arthritis complicated by a chronic myeloid leukemia associated with pyoderma gangrenosum

Rheumatoid arthritis may be associated with an increased risk of hematological malignancy. Increased lympho-proliferative malignancy in rheumatoid arthritis is often described; however an increased risk of leukemia is not a common finding. A few cases of rheumatoid arthritis have been documented associated with chronic myeloid leukemia in the literature. We report a new case.Case presentationA 36-year-old Moroccan female diagnosed as rheumatoid arthritis eight years ago, was on remission under Methotrexate and prednisone. This therapy was stopped one year before her admission at our hospital because of thrombopenia and anemia. She had polyarthritis flare. The physical examination found splenomegaly, hepatomegaly, and skin lesions at the trunk and limbs. Peripheral blood findings, peripheral smear and bone marrow aspiration diagnosed myeloid leukemia in a blastic accelerated phase with negative Philadelphia chromosome. The skin lesions were diagnosed as pyoderma gangrenosum (skin biopsy). She received oral prednisone and chemotherapy (Cytarabine and 6-Mercaptopurine). She had a complete response on the skin lesions, partial regression of splenomegaly, and improvement of her hematologic disorders. Unfortunately the patient died from septic shock after two weeks of post-chemotherapy pancytopenia.ConclusionWe report an unusual case of rheumatoid arthritis complicated by chronic myeloid leukemia associated with pyoderma gangrenosum. It is unclear whether the development of chronic myeloid leukemia in the patient with rheumatoid arthritis occurs by chance alone, is due to the underlying disease, or is facilitated by drugs. Whatever the cause is, it should be kept in mind that chronic myeloid leukemia may develop in the course of rheumatoid arthritis.     

Air pollution particulate matter (PM2.5)-induced gene expression of volatile organic compound and/or polycyclic aromatic hydrocarbon-metabolizing enzymes in an in vitro coculture lung model

The overarching goals were: (i) to develop an in vitro coculture model, including two relevant lung target cells: human alveolar macrophage (AM) isolated from bronchoalveolar lavage fluid, and immortalized cells originated from the normal lung tissue of a human embryo (L132 cell line), as a future strategy for near-realistic exposures to air pollution particulate matter (PM), and (ii) to study the gene expression of volatile organic compound (VOC) and/or polycyclic aromatic hydrocarbons (PAH)-metabolizing enzymes in this in vitro coculture model. Human AM and/or L132 cells in mono- and coculture were exposed for 24, 48 and 72 h to Dunkerque City’s PM_2.5 at its lethal concentrations at 10% and 50% (i.e. AM: LC₁₀ = 14.93 μg PM/mL and LC₅₀ = 74.63 μg PM/mL; L132: LC₁₀ = 18.84 μg PM/mL and LC₅₀ = 75.36 μg PM/mL), and the gene expression (i.e. Cytochrome P450 1A1, CYP1A1; CYP2E1; CYP2F1; microsomal Epoxide Hydrolase; NADPH Quinone Oxydo-Reductase-1, NQO1; and Glutathione S-Transferase pi-1 and mu-3, GST-π1 and GST-μ3) was studied. In human AM in mono- and coculture, and in L132 cells in monoculture, VOC and/or PAH-coated onto PM induced the gene expression of CYP1A1, CYP2E1, NQO1, GST-π1, and/or GST-μ3. However, there were quiet different outcomes based on the use of L132 cells in mono- vs. coculture: the pattern of VOC and/or PAH-metabolizing enzymes induced by PM in L132 cells in monoculture remained almost unaffected when in coculture with AM. Taken together, these results reinforced the key role of PM-exposed target human AM in the defenses of the human lung from external injuries, notably through their higher capacity to retain PM, and indicated that carbonaceous cores of PM, as physical vector of the penetration and retention of coated-VOC and/or PAH into cells, enabled them to exert a longer toxicity. The use of such a near realistic exposure system could also be a very useful and powerful tool to identify the mechanisms by which air pollution PM induced adverse health effects.     

Double-blind, comparative study of cyamemazine vs. bromazepam in the benzodiazepine withdrawal syndrome

Cyamemazine is an anxiolytic antipsychotic, which reduces ethanol withdrawal symptoms. Here, we investigated if cyamemazine can be also effective as substitute drug to facilitate benzodiazepine withdrawal. A total of 168 patients treated with benzodiazepines for at least 3 months and with a <18 score in the Hamilton Anxiety Rating Scale (HARS) were included in the study. Previous benzodiazepine treatment was withdrawn, and patients were randomized to a 4-week treatment with cyamemazine (25-50 mg q.d.) or bromazepam (3-6 mg q.d.), followed by 2 weeks of placebo. The primary efficacy variable was the maximal anxiety rebound as measured with the HARS during the 42 days of treatment. No statistically significant differences between treatment groups were found for the extent or incidence of rebound anxiety. Considering all dropout patients as withdrawal failures, after 6 months of follow-up, 56/84 patients in the cyamemazine group (66.7%) and 55/84 patients in the bromazepam group (65.5%) were successfully withdrawn. 28 patients in the cyamemazine group and 18 in the bromazepam group had an adverse event, including anxiety, insomnia, dry mouth and somnolence. No extra-pyramidal symptoms were reported. In conclusion, cyamemazine was comparable to bromazepam in ensuring successful benzodiazepine withdrawal and in controlling the acute benzodiazepine withdrawal syndrome. Cyamemazine may be useful to facilitate benzodiazepine withdrawal in those patients where bromazepam substitution is not appropriate.     

Prevalence of hospital-acquired infection in a Moroccan university hospital

BACKGROUND: Infection control and hospital-acquired infection (HAI) prevalence reports from developing countries are often not well established because of the lack of staff and resources. The aim of this study was to estimate the prevalence of HAI in a Moroccan hospital as well as to identify its predisposing factors. METHODS: A one-day prevalence survey was conducted in April 2005 at Ibn Sina University Hospital which included all inpatients who had been in the hospital for at least 48 hours. RESULTS: Among 658 patients surveyed, the prevalence of HAI was 17.8%. The prevalence was higher in intensive care units (50%). The most frequently infected sites were urinary tract (35%) and surgical wounds (32.5%). Microbiological documentation was available in only 31.6% of HAIs. The most frequently isolated organisms were Staphylococcus aureus (30%) and Proteus mirabilis (25%). Results of multiple logistic regression analysis indicated that HAI is linked to the surgical category, a hospital stay of more than 10 days, and the use of intravascular and urinary devices. CONCLUSIONS: The prevalence of HAI is high at our center. This survey provided the principal information for future surveillance and prevention programs in Morocco.     

Congenital superior sternal cleft—An unusual age of diagnosis with review of the literature

Sternal cleft is a rare congenital anomaly which is generally observed at birth and stays asymptomatic in most cases. The aetiology remains obscure. Surgery is recommended not only to protect the heart and other mediastinal contents from trauma but also to improve respiratory dynamics.We report the case of a 23-year-old young woman with a failure of the upper two thirds of the sternum, causing pain in lateral decubitus position and an aesthetic appearance problem.Through this case report we will show the chest computed tomography (CT) aspects regarding this malformation and we will give a review of the literature.     

Adult intussusceptions caused by a lipoma in the jejunum: report of a case and review of the literature

ABSTRACT: Intussusceptions in adults is rare. Gastrointestinal lipomas are rare benign tumors and intussusceptions due to a gastrointestinal lipoma constitutes an infrequent clinical entity. Lipoma may develop as a benign tumor in all organs and rarely in large or small intestine. The present report describes a case of jejunojejunal intussusceptions in an adult with a history of colicky upper abdominal pain. Ileo-ileal invagination was diagnosed by computed tomography scan. Exploratory laparotomy revealed jejunojejunal intussusceptions secondary to a lipoma which was successfully treated with segmental intestinal resection. A review of the literature is also performed regarding this rare association revealing the diagnostic and therapeutic debates that exist.