Paraclinical Aspects Research Articles

A Rare Case of Early Infantile Neuronal Ceroid Lipofuscinosis: Clinical and Diagnostic Insights

The Aim of the Study: The aim of this work is to show the different specific clinical and paraclinical aspects of ceroid lipofuscinosis in its early infantile form named Santavuori-Haltia disease through a new case.Given its rarety especially in consanguineous populations for better understanding the clinical presentation,progression and management of the disease. Introduction: The neuronal ceroid lipofuscinoses are a group of genetic brain diseases with an autosomal recessive manner characterized by the accumulation of an autofluorescent material in multiple tissues of patients. Clinically, they are progressive decline of mental and motor capacities, epilepsy and visual loss through retinal degeneration . In this work we report the early infantile neuronal ceroid lipofuscinosis or Santavuori-Haltia disease. Report Case: This is a 12-month-old infant from consanguineous parents who has presented with flexion spasms with eyelid clonia since the age of 1 month. The examination found microcephaly, and the neurological examination showed horizontal nystagmus with the absence of ocular pursuit and the presence of a pyramidal and extrapyramidal syndrome. Brain MRI shows delayed myelination. Skin biopsy confirms diagnosis. The Arg122Trp genetic mutation found is the most common one in this disease. Conclusion: Santaviori-Haltia disease is a rare and serious disease, the prognosis is severe, it must be mentioned in the face of psychomotor regression and a picture of encephalopathy. Confirmation of the diagnosis is based on histological and molecular biology data.

Isaacs' syndrome: Clinical and paraclinical perspectives in a series of cases.

Background: Isaacs' syndrome is a form of generalized peripheral nerve hyperexcitability (PNH) causing increased and continuous muscle activity characterized by muscle twitching, stiffness, cramps, myokymia, and pseudomyotonia. Herein, we aimed to review the clinical and paraclinical aspects of Isaacs' syndrome in a number of cases. Methods: We reported a series of 12 patients with Isaacs' syndrome, including their clinical features, electrophysiological findings, laboratory parameters, malignancy work-up, and therapeutic management. Results: In all cases, clinical and electrodiagnostic assessment was suggestive of Isaacs' syndrome. Of the 12 studied cases, 5 patients were positive for both leucine-rich glioma inactivated 1 (LGI1) and contactin-associated protein-like 2 (CASPR2) antibodies, 5 patients were CASPR2 positive and LGI1 negative, and 1 had borderline positive titers for CASPR2 with negative LGI1 antibody. The search for underlying malignancies was inconclusive in all subjects. After symptomatic treatment, mostly with carbamazepine or gabapentin, immunotherapies with double filtration plasmapheresis or Intravenous immunoglobulin (IVIG) provided favorable outcomes. Ultimately, all subjects fully recovered after 3-6 months of follow-up and all signs and symptoms resolved. Conclusion: Despite the rarity of the disease, our results provide valuable information for understanding the epidemiological, clinical, and paraclinical features of Isaacs' syndrome.

Appendicular Syndrome revealing ileal duplication (case report)

Introduction: Digestive duplications are rare congenital malformations in children, albeit not uncommon, characterized by a wide range of pathogenic, clinical, and histological variations. A definitive diagnosis relies on preoperative examination of the lesion followed by anatomopathological confirmation. Objective of this study was to investigate the epidemiological, clinical, and paraclinical aspects of digestive duplications, as well as their management and postoperative evolution. Herein, we present a case of ileal duplication in a 9-year-old child admitted with symptoms suggestive of appendicular syndrome, which was successfully managed with surgical treatment. Observation: The patient, a nine-year-old child, presented with symptoms consistent with appendicular syndrome. Abdominal ultrasound revealed indirect signs of appendicitis, along with minimal fluid collection in the right lower abdomen. Further exploration unveiled a mesenteric cystic mass comprising two portions, one of which was necrotic, while the appendix appeared normal. Subsequent resection of the mass was performed, and histopathological examination confirmed ileal duplication. The postoperative course was uneventful. Conclusion: Digestive duplications are rare malformations that should be considered, particularly when encountering digestive symptoms. Surgical excision remains imperative to prevent complications in an otherwise benign condition.

Epidemio-Clinical and Paraclinical Aspects of Venous Thromboembolic Diseases in a Cardiology Department in Mali

<i>Introduction</i>: Venous thromboembolic diseases (VTED) include deep vein thrombosis of the lower limbs and pulmonary embolism (PE), which is its severe form due to its high mortality. The objective of our study was to determine the epidemio-clinical and paraclinical aspects of patients hospitalized for venous thromboembolic diseases. <i>Patients and method</i>: Cross-sectional study with prospective recruitment from patient records hospitalized for (VTED) from January to December 2023 in the cardiology department of the Mother-Child University Hospital in Bamako, Luxembourg. <i>Results</i>: We collected 55 out of 580 patient records hospitalized for (VTED), a hospital frequency of 9.48%. PE accounted for 58.20% of cases, 10.90% for deep vein thrombosis (DVT), and 30.90% for their association. The mean age of patients was 55.56 years ± 15.52 years. The majority of patients, 90%, were under 66 years of age. The predominance was female, 56%. In lower extremity DVT, calf pain and Homans' sign were present in 56% and 24% of patients. In pulmonary embolism, dyspnea and chest pain were present in 85.50% and 65.50% of patients. Etiological factors were dominated by neoplasia in 10.90%, contraception 5.45% and orthopedic surgery in 5.45% of cases. Cardiovascular risk factors were a sedentary lifestyle (50.90%), obesity (34.45%), high blood pressure (36.36%) and diabetes (21.81%). Laboratory abnormalities were elevation of troponin (46.87%), BNP (40.62%), D-Dimer (62.50%) and anemia (9.09%). Electrocardiographic abnormalities were tachycardia in 65.4% and S1Q3 in 21.81% of patients. Echocardiography showed dilation of the right cavities (47.27%), systolic pulmonary arterial hypertension (38.18%) and thrombus in the right cavitary (5.45%). On thoracic CT angiography, PE was proximal (36.40%), bilateral (61.80%) and massive (29.10%). On venous Doppler ultrasound, TVP was proximal in 65.21%. <i>Conclusion</i>: VETD was more common in women and younger subjects.

Epidemiological, clinical and paraclinical aspects of Pott's disease at Brazzaville University Hospital

Objective: Describe the epidemiological, clinical and paraclinical aspects of Pott's disease at the University Hospital Center of Brazzaville. Patients and methods: This was a descriptive, cross-sectional study with retrospective collection carried out in the Rheumatology department of Brazzaville University Hospital from January 1, 2013 to June 31, 2017, i.e. 4 years and 6 months. The diagnosis of Pott's disease was based on anamnestic, clinical and paraclinical arguments. Results: The hospital frequency of Pott's disease was 6.4%. Men predominated (56.4%) with a sex ratio of 1.3. The average age was 46 +/- 16 years (range: 20-80 years). The average time to diagnosis was 6.6 ± 5 months (range: 1-26 months). Alcoholism was the most common cause in 56 cases (50.9%). Spinal syndrome was present in 109 cases (99.1%). All patients had a standard spine x-ray performed. Computed tomography was performed in 28 patients (25.5%), magnetic resonance imaging in 23 patients (20.9%). The most common morphological aspect was spondylodiscitis in 76 cases (69.1%) associating disc pinching (60%), erosion (40%), and demineralization (19.1%). Atypical forms were found in 34 cases (30.9%), dominated by the appearance of spondylitis in 21 cases (61.8%). Conclusion: Pott's disease is a common pathology in developing countries, spondylodiscitis remains the most common morphological form.

Urinary Infections in the Elderly: Socio-Demographic, Clinical and Paraclinical Aspect about a Multicenter Study in Niamey (Niger)

Introduction: Urinary infections in the elderly are common with atypical clinical signs that can impair quality of life. The objective of the study was to describe the sociodemographic, clinical and paraclinical aspects of urinary infections in the elderly at Niamey through a multicenter study. Material and Methods: This is a descriptive cross-sectional study carried out over a period of 3 months from June 1 to August 31, 2022. The study population consisted of all urine samples collected in the laboratories of the three major hospitals in Niamey for Cytobacteriological Exam of Urin (CBEU) and concern patients aged at least 60 years. Results: Of a total of 3757 samples, 110 (2.4%) were at least 60 years old. The average age was 70.8 years with standard deviation 7.4 and extremes of 60 and 93 years. The sex predominance was male in 77.3% with a majority of external origin urine collect (83.6%). The clinical complains for requesting ECBU were urinary burning in 57.3% of cases and infectious reason findings in 24.5%. Comorbidities were hypertension and diabetes found in 30 and 3.6% respectively. The appearance of urine was cloudy in 95.5%, the presence of bacteria in 96.4%, leukocytes in 95.5% and the species frequently isolated were Escherichia coli (60.9%) and Klebsiella spp (25.4%). Conclusion: The risk of complications from urinary tract infection in the elderly is common in both sexes. The clinical signs are polymorphics and the isolated germs are dominated by gram-negative bacilli, notably Escherichia coli and Klebsiella spp. Keywords: urinary infection, demography, clinic-paraclinic, geriatric, Niamey.

Cardioembolic Cerebral Accident: Epidemiological and Paraclinical Aspects at the Brazzaville University Hospital

Cardioembolic Cerebral Accident: Epidemiological and Paraclinical Aspects at the Brazzaville University Hospital

A Retrospective Observational Study: Clinical and Paraclinical Aspects of Infectious Endocarditis

A multitude of data on infectious endocarditis has already been published so far. Nevertheless, the medical care of patients with infective endocarditis remains a significant challenge, and debates on this topic will continue. The diagnosis of this pathology can be difficult, and the treatment is prolonged and presents many challenges, as patients with infective endocarditis are susceptible to numerous both local and systemic complications. We correlated data from the medical records of patients hospitalized with infective endocarditis to analyze their predisposing conditions, clinical and biological parameters, and treatment outcomes. We concluded that infective endocarditis most commonly affects patients over 60 years who already have structural valve changes, most often involving the aortic valve, with the course of patients being mostly burdened by perivalvular abscesses.

Viral Hepatitis B and C: Epidemiological, Clinical and Paraclinical Aspects in the Internal Medicine Department of KARA University Hospital in Togo

Viral Hepatitis B and C: Epidemiological, Clinical and Paraclinical Aspects in the Internal Medicine Department of KARA University Hospital in Togo

Hypersensitivity pneumonitis from Diagnosis to Treatment: A Cases Series with Literature Review

Hypersensitivity pneumonitis (HP) classified as an interstitial lung disease is characterized by a complex immunological reaction of the lung parenchyma in response to repetitive inhalation of a sensitized allergen. The estimated worldwide incidence of hypersensitivity pneumonitis is extremely rare and highly dependent on climatic, geographical, occupational and industrial factors. It might be secondary to a domestic or professional exposure, usually occurs in people who work in places where there are high levels of dust, fungus, or molds. Long-term exposure can lead to lung inflammation and acute lung disease. Over time, the acute condition turns into long-lasting (chronic) lung disease. Thus, we distinguish 2 mains aspects fibrotic HP and Nonfibrotic HP. The diagnosis of HP maybe sophisticated especially in fibrotic form. The prognosis of this disease depends on early diagnosis with complete antigen avoidance and most often corticosteroid therapy. This work aims to study the epidemiological, clinical, paraclinical aspects of hypersensitivity pneumonitis as well as therapeutic management, through a series of eight cases of HP carried out at the Pulmonology Department 20 August 1953, University Hospital Center IBN ROCHD, between January 2020 and January 2022, analyzed using a pre-established exploitation sheet. The average age of the patients studied was 51 years with a female predominance (sex-ratio M/F= 0.34). Domestic and occupational exposures of our patients were equal. The clinical symptomatology is dominated by almost constant dyspnea in all patients. Physical signs increased by crackles, objectified in 75% of patients. Computed tomography (CT) remains a great diagnostic contribution. Thus, allowing to have two categories of patients, depending on the presence or absence of signs of pulmonary fibrosis. In our study, five patients had fibrotic HP, and three cases had non- fibrotic HP. Precipitins were positive. Plethysmography objectified a restrictive ventilatory disorder in 62.5%. All patients benefited from antigenic eviction with long-term corticosteroid therapy. The evolution was favorable in 87.5% of cases.

Extrapulmonary Tuberculosis – a Rare Cause of Difficult Evolution in a Case Of Extensive Anoperianal Suppuration

Extrapulmonary tuberculosis is very rare, representing around 15% of all tuberculosis (TB) cases. Intestinal localization of extrapumonary TB occurs in 1% of the cases and is usually associated with HIV infection. The last portion of the ileum and the ileocecal region are most frequently involved, while perianal localization is extremely rare and has clinical and paraclinical aspects similar to Crohn’s disease, thus leading to difficulties in establishing the diagnosis. We present the case of a 41-year-old patient who came to the proctology department with perianal pain and purulent discharge. He was diagnosed by clinical examination and colonoscopy with multiple simple and complex perianal fistulas complicated with a supralevator abscess. Multiple biopsies were taken and the result was necrotizing granulomatous inflammation. The Ziehl-Neelsen test confirmed the suspicion of perianal TB.

ISCHEMIC STROKE A COMPARATIVE RETROSPECTIVE STUDY: EXPERIENCE OF MILITARY HOSPITAL OF MEKNES

Cerebrovascular accident (stroke) is defined by a localized neurological deficit of sudden onset which persists for at least 24 hours. It is a frequent pathology whose social and economic burden remains very heavy. In Morocco, stroke is responsible for several thousand hospitalizations each year. Its estimated incidence would be 300 /100,000 inhabitants objective of the study is the epidemiological profile, clinical and paraclinical aspects as well as preventive management associated with Ischemic stroke at the intensive care unit of Moulay Ismail military hospital Retrospective study carried out from January 1, 2019 to December 31, 2019. We collected 66 patients for whom all the parameters studied were collected on a preestablished operating sheet then entered into Microsoft Excel, and analyzed using the chi2 software. The study concerned 66 patients: 1. The mean age of the patients was 64.92 years (range 38 and 82), of which 63.6% of the patients were over 65 years old. 2. High blood pressure was the main risk factor, followed by diabetes type 2 as most of the series described in the literature. 3. The average time between the onset of symptoms and the emergency room visit was 66.2 hours. 4. Hemiplegia was the main clinical sign found on examination. 5. The brain scan q pathological in 93.9% of cases. 6. None of our patients benefited from thrombolysis. 7. The death rate has been estimated at 46.6%. 8. The interest of prevention in reducing the frequency and morbidity – mortality of stroke.

Establishing Patient-Centered Outcomes for MCT8 Deficiency: Stakeholder Engagement and Systematic Literature Review.

The SCL16A2 gene encodes the thyroid hormone (TH) transporter MCT8. Pathogenic variants result in a reduced TH uptake into the CNS despite high serum T3 concentrations. Patients suffer from severe neurodevelopmental delay and require multidisciplinary care. Since a first compassionate use study in 2008, the development of therapies has recently gained momentum. Treatment strategies range from symptom-based approaches, supplementation with TH or TH-analogs, to gene therapy. All these studies have mainly used surrogate endpoints and clinical outcomes. However, the EMA and FDA strongly encourage researchers to involve patients and their advocacy groups in the design of clinical trials. This should strengthen the patients' perspective and identify clinical endpoints that are clinically relevant to their daily life. We involved patient families to define patient-relevant outcomes for MCT8 deficiency. In close collaboration with patient families, we designed a questionnaire asking for their five most preferred therapeutic goals, which, if achieved at least, make a difference in their lives. In addition, we performed a systematic review according to Cochrane recommendations of the published treatment trials. We obtained results from 15 families with completed questionnaires from 14 mothers and 8 fathers. Improvement in development, especially in gross motor skills, was most important to the parents. 59% wished for head control and 50% for sitting ability. Another 36% wished for weight gain, 32% for improvement of expressive language skills, and 18% for a reduction of dystonia/spasticity, less dysphagia, and reflux. Paraclinical aspects were least important (5-9%). In a treatment trial (n=46) and compassionate use cases (n=83), the results were mainly inconclusive, partly due to a lack of predefined patient-centered clinical endpoints. We recommend that future trials should define a relevant improvement in "development" and/or other patient-relevant outcomes compared to natural history as treatment goals.

Particularities regarding Clinical-biological and Evolutive Parameters of Immune-mediated Rheumatic Diseases in Patients with COVID-19 – systematic literature review

Background: Since its outbreak in 2019, Coronavirus disease 2019 (COVID-19)/Severe Acu-te Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was a serious medical threat and was declared Global Pandemic, triggering fear, panic and uncertainty for people around the Globe. Among those individuals, there is a specific category of patients – the ones with immune-mediated rheumatic diseases (IMIDs) – whose mantra from the diagnosis was to avoid infections at all costs because of the additional negative impact on the immune sys-tem and overall reactivity. Objective: Considering the aforementioned, our objective is to understand the in-depth relation of the immune system of patients with IMIDs in the set-ting of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), and the real bur-den of the disease and vaccination against COVID-19. Materials and Methods: In this res-pect, we have conducted a thoroughly systematic literature review according to the “Prefer-red Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” concept. Following its five-steps algorithm, we first selected 745 articles that were published in re-putable international medical databases, ISI-indexed, for the period 1 January, 2021–31 December, 2022. After consequent elimination of duplicates, of articles that were not En-glish-written and “open access” and then applying PEDro classification/scoring-inspired, only 58 articles were selected for in-depth full qualitative reading. In the last stage,20 arti-cles were “excluded with reasons”, because they didn’t offer significant information. The-refore, in our systematic literature review, 38 articles were included.Results: In the data gathered in this review we described the molecular pathways of activation of the immune system triggered by COVID-19, with significance on the clinical and paraclinical aspects of IMID patients infected with the new Coronavirus. Patients with IMIDs are at higher risk for hospitalization if diagnosed with SARS-CoV2 and more prone to severe outcomes and death. Risk factors associated with severe outcomes and death are: age, comorbidities, un-derlying disease activity, therapies used (“the good” being anti-tumor necrosis factor α, “the bad” – Methotrexate, Sulfasalazine, Azathioprine and “the ugly” – anti CD20 mono-clonal antibodies). There were several reports of flares and new-onset of IMIDs after CO-VID-19 and after vaccination against this disease, but data from larger studies and registri-es do not confirm higher incidence of flare-ups or new-onset IMIDs. Regarding vaccination, of mounting importance is the timing between immunomodulatory and immunosuppres-sive agents and the administration of the vaccine. And last but not the least, we discussed about Long COVID and the role of artificial intelligence in the pandemic and related-drug development. Discussion and Conclusion: The data in our systematic literature review is consistent with the expertise from our clinical practice. This article is the first part of the doctoral study that is centralized on the same topics, with the current objective of deepe-ning the knowledge about the intersection of COVID-19/SARS-CoV2 and immune-mediated rheumatic diseases and a future objective: to compare information we have synthetized here with our database of almost 170 Romanian patients with a IMID and COVID-19/SARS-CoV2. The next objective is to extend the study to a multicenter control one. Keywords: SARS-CoV2, COVID-19, Immune Mediated Rheumatic Diseases, Rheumatoid Arthri-tis, Systemic Lupus Erythematosus, COVID-19 Vaccine, Long COVID

EPIDEMIOLOGY OF CARDIOVASCULAR MORTALITY IN PATIENTS AGED UNDER 60 IN THE CARDIOLOGY DEPARTMENT FROM SEPTEMBER 2019 TO AUGUST 2022

Objective: The objectives of our study were to study the cardiovascular mortality of the active population, to analyze the epidemiological, clinical, paraclinical aspects, the complications and to determine the etiological aspects related to this mortality. Design and method: This was a descriptive and analytical retrospective study over 3 years from September 2019 to August 2022 in patients aged at least 15 and at most 60 years old hospitalized and deceased in the cardiology department of the General Idrissa POUYE hospital in Dakar. The data was recorded on a survey sheet and entered into the EPI Info 7.2.5.0 software, and the analysis carried out by the R. Studio software version 2022.12.0 + 353 and Excel 2019. The significance threshold retained was a p value < 0.05. Results: Our study enrolled 73 dead patients, either a specific mortality of 8.8% and a proportional mortality of 39%. The predominance was male with a male/female sex ratio of 1.2. The average age was 44 years old. The cardiovascular risk factors found were dominated by physical inactivity (76.7%), hypertension (28.8%) and smoking (21.9%). Physical examination found signs of heart failure in 63% of cases. Biology noted above all anemia (59%), impaired renal function (25%) and high troponin in 87% of cases. The electrocardiogram essentially found arrhythmias (46.6%). The chest X-ray mainly showed cardiomegaly (49.3%), pleuro-pneumonopathy (33%). Echocardiography showed altered LVEF (81%), PAH (78%) and kinetic disorders (40%). Coronary angiography, performed in 4 patients, showed 2 bi-truncal lesions, 1 mono-truncular and 1 tri-truncular. The most used treatments were diuretics (63%), amines (47.9%), AVKs (42%), BBs (36%), ACE inhibitors or ARA2 (31%). Thrombolysis was performed in 5 SCA and 4 PE and angioplasty in 4 patients. The analytical study shows that the data most related to mortality were age, socio-economic level, ischemic heart disease (p = 0.034), rheumatic valvular disease, pulmonary embolism (p = 0.034), hypertension (p = 0.009), smoking (p = 0.011), diabetes (p = 0.011), dyslipidemia, bed rest (p = 0.001), morbid obesity (p = 0.001) and infection with COVID-19 (p = 0.017). Conclusions: The predominance of ischemic heart disease, pulmonary embolism and valvular heart disease in premature mortality statistics should encourage strengthening cardiovascular prevention.

Autoimmune pancreatitis with different clinical manifestations and imaging findings: a series of three cases

Autoimmune pancreatitis (AIP) is a rare and emerging immune-mediated pancreatitis. The involvement of the pancreas with lymphoplasmacytic infiltration and fibrosis on histology is the most common features and has been well studied in the literature. It is characterized by a nonspecific presentation that mimics a malignant process. The purpose of this report is to explore the different clinical and paraclinical aspects of this disease, as well as the challenges posed by its management. The series are made up of three different cases of patients with elevated serum IgG4 levels and pancreatic changes. The first case initially revealed cholestatic jaundice with extrahepatic and intrahepatic cholangitis, and ultrasound reflected multiple occupying changes in the pancreas. The elevated serum IgG4 level was brilliant. Patient improved under the influence of corticosteroids. The second case was clinically asymptomatic, just found weight loss. Magnetic resonance revealed a round mass in the head of the pancreas and was considered as a neuroendocrine tumor. The patient showed slightly elevated serum IgG4 level, but was sensitive to hormone therapy. The third case concerned epigastric pain and enlarged lymph nodes. It was initially diagnosed as pancreatic cancer with distant metastasis, but also finally resolved by corticosteroid treatment. The clinical presentation of AIP is heterogeneous, as evidenced by our three clinical cases. Further observational and interventional studies are needed to better identify and manage this disease.

Epidemiological, Clinical and Lifestyle Profile of Patients Diagnosed with Oral Cancer in Senegal

Oral cavity cancers (OCC) are malignant tumours that develop from tissues of buccal cavities. The objective of this study was to describe the epidemiological, clinical and lifestyle profile of patients diagnosed with OCC in Senegal. A multicentre cross-sectional study of 45 patients was conducted. Patients aged 18 years and older with histologically confirmed lesions of the oral cavity were included in the study. Data were collected on socio-demographic characteristics, clinical and para-clinical aspects, and lifestyle habits of the OCC patients. A survey directly administered to patients was used. Data entry was performed with Epi 7.2 software and descriptive analysis with Stata 17/IC. More than half (55.56%) of the patients were female. The average age was 53.09±16.80 years. The hospital university Aristide Le Dantec accounted for 55.56% of the study participants. More than 4/5 of the patients had come on their own to a consultation for an objective clinical symptomatology. The average size of lesions was 6.66±3.3 centimetres. More than 2/3 were diagnosed in the advanced stage. Less than 40% of patients had a diet rich in fruits and vegetables. Nearly 65% admitted to having oral sexual activity. The data from this study show that the profile of patients diagnosed with OCC is 50 years old, predominantly female, and not a consumer of known risk factors.

Parathyroid Cancer—A Rare Finding during Parathyroidectomy in High Volume Surgery Centre

Background and Objectives: Parathyroid cancer is a very rare endocrine tumor, especially in patients with secondary hyperparathyroidism due to end stage renal disease failure. This pathology is difficult to diagnose preoperatively because it has nonspecific clinical manifestations and paraclinical aspects. Our study of the literature identified 34 reported cases of parathyroid carcinoma over the last 40 years in patients undergoing dialysis. We present our experience as illustrative of the features of clinical presentation and histopathological findings of parathyroid carcinoma and assess its management considering the recent relevant literature. Materials and Methods: From January 2012 to November 2022, 650 patients with secondary hyperparathyroidism undergoing dialysis were treated at our academic Department of General Surgery and only two cases of parathyroid carcinoma were diagnosed on histopathological examination. Results: All patients presented with symptomatic hypercalcemia, with no clinical or imaging suspicion of malignant disease and were surgically treated by total parathyroidectomy. Histopathological examination revealed morphologic aspects of parathyroid carcinoma in two cases and immunostaining of Ki-67 was performed for diagnostic confirmation. Postoperative follow-up showed no signs of recurrence and no oncological adjuvant treatment or surgical reinterventions were needed. Conclusions: Parathyroid neoplasia is a particularly rare disease, that remains a challenge when it comes to diagnosis and proper management. Surgical approach is the only valid treatment to remove the malignant tissue and thus improve the patient's prognosis. Medical and oncologic treatment may be beneficial to control hypercalcemia in case of tumor recurrence.

Neuromyelitis optica spectrum disorders with and without associated autoimmune diseases.

We aimed to determinate the frequency of this association and compare the features of neuromyelitis optica spectrum disorder (NMOSD) with and without associated autoimmune diseases (AD) in a Latin American (LATAM) population in clinical practice. We retrospectively reviewed the medical records of patients with NMOSD according to the 2015 diagnostic criteria. Patients from Argentina (n=77), Brazil (n=46), and Venezuela (n=17) were enrolled and classified into two groups as follows: with AD or without AD. Clinical, paraclinical (including aquaporin-4 antibodies (AQP4-ab) status), magnetic resonance imaging (MRI), and prognosis data were analyzed and compared. Kaplan-Meier (KM) and the Nelson-Aalen estimator analyses were performed to estimate both time and the cumulative hazard risk of disability reaching an EDSS≥4; and time for the first recurrence. Out of 140 patients, 33 (23.5%) patients had associated an AD at presentation. The most frequent associated AD was Hashimoto disease (n=10) followed by lupus (n=7) and Sjogren's syndrome (n=6). However, rituximab use (42.4% vs. 21.5%, p=0.02), female gender (82.2% vs. 100%, p=0.006), corticospinal lesions on MRI (0% vs. 12.5%, p=0.01) at onset, and positivity for antinuclear antibodies (21.2% vs. 48.4%, p=0.03) were significantly associated with NMOSD patients with AD in comparison to NMOSD patients without AD. No differences were found in other clinical and paraclinical aspects between groups. KM and Nelson-Aalen estimator analyses did not show differences between groups. NMOSD patients associated with AD were observed in 23.5%. In addition, NMOSD patients with and without associated AD were similar in most evaluated features.

Retrospective cross-sectional study of 34 cases of pernicious anemia at Mohammed V Military Training Hospital, Morocco.

pernicious anemia is an autoimmune disease characterized by atrophic gastritis due to malabsorption of vitamin B12. Certain oral manifestations, such as Hunter´s glossitis and burning mouth syndrome, may precede the onset of this anemia. The aim of this study is to describe the clinical presentation, para-clinical aspects, the treatment, and the evolution of the pernicious anemia (PA) after treatment. retrospective study conducted at the Department of Haematology and Internal Medicine B of the Mohammed V Military Training Hospital in Rabat between January 2009 and December 2018. Thirty-four patients were enrolled with vitamin B12 deficiency, non-regenerative macrocytic anemia, a positive anti-intrinsic factor antibody and anti-parietal cell antibody and a histological diagnosis of atrophic gastritis in the presence or not of Helicobacter pylori. The qualitative variables were expressed in numbers and percentages, and the quantitative variables in mean and standard deviation. Multivariate analysis used the Fischer test; it was considered significant for a p < 0.05 value. thirty-four cases were studied; the population study consists of 56% (n=19) of men and 44% (n=15) of women. The average age was 54.88± 9.14. The clinical manifestations of pernicious anemia are dominated by megaloblastic anemia 85.3% (n=29), followed by digestive 58.8%(n=20) and oral 55.9% (n=19) signs. Neurological manifestations were rarely found in 41% (n=14). Hunter´s glossitis 37% (n=7), stomatodynia 11% (n=2) were the most common oral manifestations accompanying pernicious anemia. The evolution was favorable in 79.4% (n=27) patients under substitution therapy with vitamin B12. dentists´ involvement in the diagnosis of pernicious anemia is based on changes in oral mucous membranes, which have been reported in 55.9% of all patients. These oral changes may occur in the absence of symptomatic anemia.