Screening for childhood lead poisoning in the industrial region of Fez, Morocco

The study objectives were to estimate lead poisoning prevalence among children living next to an industrial area, to compare it to that in a control population, and to establish clinical and biological follow-up of the poisoned children. This is a descriptive cross-sectional study including 150 children (exposed and unexposed) performed between January 2012 and April 2013. It was meant to determine blood lead levels (BLLs) in children considered to be an exposed population (EP N 90), living in the industrial area Ain Nokb Fez compared with BLLs of children of other areas belonging to the same city supposed to be unexposed [UP (N = 60)]. A sociodemographic questionnaire was obtained, and a blood lead analysis was performed. Clinical and biological follow-up has been performed of poisoned children. The sample consisted of 90 EP children with an average age of 6.82 ± 3.32 years and male-to-female sex ratio (SR) of 1.5 and 60 UP children with an average age of 6.45 ± 3.29 years and an SR of 1.2. Among the 150 children recruited, the average of BLLs was 58.21 ± 36 µg/L (18-202.3 μg/L). The average of BLLs in EP children (71 ± 40 µg/L) was statistically greater (p < 0.0001) than that registered in UP children (38 ± 13 µg/L). All poisoned children belonged to the EP group at a prevalence of 21.1 %. The clinical and biological examinations of poisoned children showed a few perturbations such as anemia, hypocalcaemia, and deficiencies in magnesium and iron. No renal disease or objective neurological disorders were observed. In the follow-up of the children with BLL ≥100 µg/L (19 cases). BLL monitoring showed a significant decrease in average of blood concentration ranging from 136.75 ± 32.59 to 104.58 ± 32.73 µg/L (p < 0.0001) and in lead poisoning prevalence (p < 0.001), which decreased to 7.8 % from 21.1. Our study showed a high prevalence of lead poisoning (21.1 %) in EP children. The relocation of the industrial site associated with corrective and preventive measures has contributed to a decrease of exposure and lead poisoning prevalence in the aforementioned population.

[Overdose or hypersensitivity to vitamin D?]

Vitamin D intoxication with severe hypercalcemia is rare in the neonatal and infancy period. Through nine cases of hypercalcemia, secondary to taking 600,000 units of vitamin D (Sterogyl(®)), a review of vitamin D requirements and possible mechanisms of toxicity including hypersensitivity to this vitamin will be discussed. We report nine cases of babies admitted to our department between the ages of 25 and 105 days for treatment of severe dehydration. The pregnancies were normal, with no incidents at delivery. Clinical signs were dominated by weight loss, vomiting, and fever. Examination on admission revealed dehydration whose degree ranged from 8 to 15% with preserved diuresis and loss weight between 100 and 1100 g. Laboratory tests objectified hypercalcemia between 113 and 235mg/L, hypercalciuria (urinary calcium/creatinine mmol/mmol >0.5), and a low-level of parathyroid hormone. The vitamin D values in nine patients were toxic (344-749 nmol/L; normal >50 nmol/L; toxicity if >250 nmol/L). Abdominal ultrasound objectified renal nephrocalcinosis in seven patients. The DNA study, performed in eight patients, did not reveal a mutation of the vitamin D 24-hydroxylase gene (CYP24A1). The treatment consisted of intravenous rehydration with treatment of hypercalcemia (diuretics and corticosteroids). Serum calcium returned to the normal range within 4-50 days, with weight gain progressively over the following weeks. The follow-up (2 years for the oldest case) showed the persistence of images of nephrocalcinosis. Genetic susceptibility and metabolic differences appear to modulate the threshold of vitamin D toxicity. However, respect for recommended doses, recognized as safe in a large study population, reduces the risk of toxicity.

[Choriocarcinoma: a hidden face of pemphigoid gestationis]

Gestationis pemphigoid is an autoimmune subepidermal blistering dermatosis occurring predominantly in pregnancy, more seldom in early puerperium, and exceptionally in post-abortion. The association of gestationis pemphigoid with choriocarcinoma is extremely rare. We report this association in a patient of 35 years in which the diagnosis of gestationis pemphigoid was made on clinical, histological and immunological criteria, and the one of choriocarcinoma was made on clinical, biological radiological and histological criteria. Through this article, we put the item on this association reported for the first time in post-abortion.

Post-menopausal endometrial tuberculosis mimicking carcinoma: An important differential diagnosis to consider

We report the case of a menopausal 74-year-old patient who presents pyorrhoea for 6months. We suspect initially a carcinoma process, but the anatomopathological examination takings obtained by biopsy curettage of the endometrial under hysteroscopy is in favor of an inflammatory infiltrate with epithelioid and giant cells of type Langhans and type Muller without caseous necrosis. The bacteriological direct examination after coloring of Gram, Ziehl-Neelsen and Sabouraud was negative. The bacteriological culture in the Löewenstein and Coletsos environment identified Mycobacterium tuberculosis. The searches for another source of the infection was negative both at the pulmonary and urinary levels. An antituberculous quadritherapy allows the fast clinical improvement. The tuberculosis remains frequent but rarely genital. It is especially the case of young women, from non industrialized countries, consulting for infertility. It is necessary to know how to evoke it front in pelvic symptoms, whatever the age is and to realize easily mycobacteriological examinations.

[Epidemiological and pathological features of cancer in Fez Boulemane region, Morocco]

In Fez-Boulemane, Morocco, there is no cancer registry so there is a lack of information about the incidence and characteristics of cancer in the region. In this retrospective study we examined the epidemiological and pathological features of 5532 cases of cancer collected from the Department of Pathology in Hassan II University Hospital of Fes from 2004 to 2010. The mean age of the patients was 53.5 years and 52% were male. Digestive cancers and skin cancers were the most common. Digestive cancers were predominantly colorectal and stomach. Cancers of the urinary bladder and colorectal cancers were the leading cancers in men accounting respectively for 9% and 8% of all male cancers. In women, cancers of the breast (62%) and uterine cervix (22.6%) predominated. As a first step in cancer control in our area, establishment of a regional cancer registry is recommended.

[Desmoid tumor of mediastinum revealed by superior vena cava syndrome and tamponade]

Desmoid tumors are rare forms of low grade malignancies. They are characterized by a strong potential of local invasion. Although they are considered histologically benign they behave aggressive locally. They typically occur in the abdominal wall or within the abdomen. Mediastinal localisation is very rare. The only curative treatment is wide surgical excision but the surgery is difficult and the risk of local recurrence is high.

[Epidemiological and biologic profile of breast cancer in Fez-Boulemane, Morocco]

In a retrospective study of 265 patients with breast cancer over 3 years (January 2007-September 2009) we examined the epidemiological profile of breast cancer to determine the impact of biological and prognostic factors on survival over 3 years and on the epidemiology of this cancer. Estrogen (RE), progesterone (RP) and human epidermal growth factor receptors (HER2) were evaluated and RE/RP/HER2 status determined. The patients were young (median age 45 years). Invasive tumours were found in 95.5% of the women. The average tumour size was big [3.6 (SD 2.6) cm] and only 14% were histological grade 1. Large tumour size and high histological grade were independent of patient's age. Overall survival at 3 years was only 49% for the RE-/RP-/HER2- subtype and 75% for the RE-/RP-/HER2+ subtype, while it was 96% for the RE+/RP+/HER2- subtype. The young age, large tumour size and high histological grade in our population suggest a lack of awareness of women about breast cancer.