[Schizotypal personality in academia]

INTRODUCTION

Schizotypal personality, otherwise known as "latent schizophrenia" is a personality disorder accepted in the spectrum of schizophrenia. Its prevalence is 3% of the general population. The schizotypal personality questionnaire (SPQ) developed by Raine is one of the most-widely used auto-evaluation instruments for the study of this personality disorder, it allows the rapid diagnosis of schizotypal personality, using 74 items divided into nine lower scales, evaluating the total DSM IV-R criteria of this disorder.

AIM OF THE STUDY

To explore the schizotypal personality among students in two Moroccan establishments, the medical school in Marrakech and the College of Technology in Safi (EST), through the Raine's SPQ, and to describe the sociodemographic profile of students with schizotypal traits.

METHODS

This is a retrospective study concerning a sample of the first round students in two university sites in Morocco (the medical school in Marrakech and the College of Technology in Safi). The investigation began on October 2004 and was spread over a period of 6 months. The questionnaire was anonymous, divided into two parts; the first part concerning sociodemographic characteristics and the second exploring the SPQ, developed by Raine, assessing nine schizotypal traits specified as such in the DSM IV-R.

RESULTS

The average score was 25.33 ± 11.77; with the upper and lower threshold values 44/74 and 10/74 respectively. Males were predominant among schizotypal students (7.24% versus 3.62% among females). Moreover, most of the schizotypal students (16.7%) were living with their parents, 1.4% living alone and only 0.7% with their friends. In the schizotypal students, 11.6% were pursuing their studies in the College of Technology in Safi, and 6.8% in the medical school of Marrakech. The average score for the SPQ was 25.33 ± 11.77 (minimal score 2/74 and maximal score 52/74). Excessive social anxiety total score was 518, the distrust total score was 496, and the lack of close friends total score was 449. Concerning scores for the sub scales: poverty affects, bizarre speech, reference ideas, perceptual experiences, unusual and bizarre beliefs, were respectively 434 (mean 2.94), 430 (mean 2.91); 422 (mean 2.88), 410 (mean 2.66), 337 (mean 2.30). Bizarre and eccentric behavior's total score was 309 (mean 1.97). Finally, our study could not find a relationship between the schizotypal disorder and the consumption of illicit drugs.

DISCUSSION

Schizotypal personality disorder is considered as a trouble-generator spectrum of schizophrenia; patients with this disorder are at high risk of developing schizophrenia, particularly when not detected earlier. The average SPQ questionnaire score in our sample was 25.33+11.77. Very similar scores are found in other studies concerning student populations. According to the method of Raine threshold, scores have been defined by the values corresponding to 10-degree and 90-degree percentile distribution of collected scores. In our study, these lower and upper threshold scores were 10/74 and 44/74 which appear similar to those calculated by Raine (12/74 and 41/74), Dumas et al. (9/74 and 40/74), Dumas et al. (7/74 and 40/74), and in the study of Gaha et al. who found upper and lower threshold score of respectively 9/74 and 42/74. Several epidemiological studies conducted since the early 1990s indicate that the lifetime prevalence of drug consumption (abuse or dependence) is nearly 50% in schizotypal personality before the outbreak of schizophrenic symptoms, schizotypal personalities tend to consume these substances to relieve their anhedonia, to socialize and to allay their anxiety, which explains the co-occurrence of schizophrenia and drug consumption.

[Askin tumor: a case report with literature review]

Askin tumor is a rare malignant tumor arising from soft tissues of the chest wall, rarely in the lung. It occurs predominantly in young adults. It still raises many questions about its individualisation and its links with Ewing's sarcoma. We report a case of Askin tumor in a 5-year-old child with reviewing the different data from the literature.

[Systemic lupus erythematosus and Epstein-Barr virus]

We determined the prevalence of antibodies to Epstein-Barr virus (EBV) in 44 patients with systemic lupus erythematosus (SLE) and 44 healthy blood donors matched for sex and age as controls. Of the cases, 39 were women; mean age was 33 years. Four cases (9%) and 5 controls (11%) were positive for IgM anti-viral capsid antigen (VCA) (P = 0.9). All the cases were positive for IgG anti-VCA compared with 91% of the controls (P = 0.12). The mean immunity ratio for this antibody was 2.341 in cases and 1.873 in controls (P = 0.068). Forty (91%) cases were positive for IgG anti-EBNA1 (EB nuclear antigen1) compared with 42 (95%) controls (P = 0.6).

Sjögren's syndrome associated with multiple myeloma

There have been very few reported cases of multiple myeloma (MM) which had Sjögren syndrome (SS) as the first presentation. We report a 63-year-old Moroccan woman with IgA-lambda-type MM presenting as SS and who responded to anti-myeloma treatment. The patient, treated for SS, was admitted to our department for persistent and increasing thoracic pain. Clinical examination was normal. Laboratory investigations showed haemoglobin of 10 g/dL. Erythrocyte sedimentation rate was 80 mm/hr. Monoclonal spike was found in the betaglobulin region of the serum protein electrophoresis. Immunofixation identified it as IgA lambda and the level was 3.7 g/dL. The bone marrow contained 35 percent plasma cells, with atypical features. Radiographs showed diffuse lytic lesions. Treatment with vincristine, adriamycin and dexamethasone (VAD) was started and bisphosphonate was administered regularly. After three cycles of VAD therapy, the MM regressed without any evidence of SS symptoms. The development of MM in the setting of SS is unusual and the aetiopathogenic mechanism still unknown. However, some elements orient toward a common pathway for these two diseases, like the clinical remission of SS after treatment of the MM, such as described in our patient.

Therapeutic plasma exchange in Casablanca

BACKGROUND

Therapeutic plasma exchange (TPE) is an extracorporeal blood purification method for the treatment of diseases in which pathological proteins have to be eliminated. In the aim to demonstrate our single center activity, we analyzed our data since 2 years.

METHODS

Between years 2002 and 2005, 104 TPE procedures were performed on 42 patients. Median age and male/female ratio were 32 (range, 17-56) and 24/18, respectively. Departments those referred the majority of the TPE were neurology (n=32), nephrology (n=5) and intensive care unit (n=5). The most common indications were: polyradiculoneuropathies (53%), myasthenia gravis (17%) and Guillain-Barré syndrome (12%).

RESULTS

The median TPE procedure per patient was 2.3 (range, 1-10). In the majority of patients, vascular access was provided by puncture of two large, durable peripheral antecubital veins. The procedures were performed with the "Haemonetic Ultralight" discontinuous flow cell separator devices. Citrate solution was used as an anticoagulant in all cases. The substitution fluids most often used in our unit are Albumin 20% solution (92 times), Albumin 4% (10 times) and fresh frozen plasma (twice). Seventy five percent of the patients showed improvement, 7% remained the same and 18% worsened. Thirteen adverse reactions were recorded.

CONCLUSION

The creation of a national registry by the local society is a vital move to improve TPE practice in our country.

[Cerebral hydatic cyst and psychiatric disorders. Two cases]

The hydatidosis is an endemic illness in regions of the Middle Orient, Mediterranean, south of America, north Africa and the Australia. The preferential localization of cyst hydatic is the liver (48%), the lung (36%) and in 6% of cases it localizes in unaccustomed place as the brain. Intracerebral localization is relatively rare, its impact is 1 to 5% of all cases of hydatidose. This localization is the child's appendage with a masculine predominance. The cyst hydatic intracranien is often lone, of localization usually supratentorielle, sometimes infratentorielle. Symptoms are especially the diffuse headache associated to various neurological signs in relation with sits of the tumor. The psychiatrics symptoms depends on its localization, sides, intracranial hypertension, and the previous personality. In 15 to 20% of cases these tumors can appear in the beginning of their evolution by the isolated psychiatric symptoms. We report the case of two patients that have been hospitalized first in the Academic Psychiatric Unit of Marrakech for isolates psychiatric disorders and whose scanning revealed the presence of cerebral hydatic cyst and that required a surgical intervention in neurosurgery. Case 1 - Patient 29 years old, bachelor, uneducated, leaving in country outside, fermar, in permanent contact with dogs. No particular medical history. The patient has been brought by his family to the psychiatric emergencies after behavior disorders. The beginning of his symptomatology was one year ago by behavior disorders: instability, violence, isolation, and a corporo-sartorial carelessness. His symptomatology worsened and the patient became very aggressive. In psychiatric unit, he was disregarded, sad, anguished, indifferent to his state, very dissonant, completely detached, depersonalized. He brought back some visual and auditory hallucinations with attitude of monitoring. He was raving with delirium of persecution, of ideas of reference and delirium of bewithment. He was unconscious of his disorders. The patient has first been put under classical neuroleptic 9 mg/day of Haloperidol and 200 mg/day of chlorpromazine. The diagnosis of schizophrenia has been kept according to criteria of DSM IV. The PANSS (Positive and Negative Syndrome Scale) was to 137 (score on a positive scale was to 34, score on a negative scale was to 35 and the general psychopathologie scale was to 58). One week after his hospitalization, he developed headache with subconfusion, a cerebral scanning has been made in emergency and showed a voluminous cyst in oval foramen compressing the mesencephalon strongly. The cyst was well limited, hypodense, not taking the contrast, and without intracerebral oedema, the diagnosis of cerebral hydatic cyst has been made. The complementary exploration didn't show any other localizations, and biologic exam results didn't show any particular anomalies. The patient has been operated in neurosurgery. The immediate evolution was favorable with disappearance of confusion and absence of complications. The patient was lost of view. Six months after, the patient has been readmitted to the psychiatric emergency. He dropped his neuroleptic treatment. He was aggressive, raving, hallucinated and depersonalized. The global score to the PANSS was 63. He has been put back under neuroleptics. Three weeks after improvement and passage of the PANSS to 30, the patient went out. We couldn't have a cerebral scanner of control because the patient had no medical assurance and no money for cerebral scanner. Case 2 - Patient aged of 53 years, father of four children, uneducated, native and resident of Marrakech, confectioner as profession. He is in contact with dogs since 12 years. He has been brought to the psychiatric emergencies by his family after an agitation. The history of his illness seemed to go back at eight months ago, by the progressive apparition of an instability, sleep disorders, hostility, associated with an emotional lability. To the interview he was agitated and had a delirium of persecution. He was convinced that his wife and his children plotted against him. He had sad mood. He was anguished and had auditory and visual hallucinations. The patient was not confused but it had a hypoproxie, an fixing amnesia, a disorders of judgment and a light left hemiparesia. Cerebral scanner revealed three cerebral cyst. The first measuring 42 x 40 mm, sitting at the level parietal right, to the contact of the occipital horn, dragging his/her/its amputation and an effect of mass on ventricle homolateral, the median line and ventricle controlateral. The two other, at the level of the center semi oval, behind the first, measuring 23 mm and 15 mm on the big axis. The patient has been addressed in neurosurgery. He had a completeray exploration to search other localizations. The thoracic x-ray showed 2 pulmonary cyts. The abdominal scan and imagery by magnetic resonance showed liver cyst, peri-heart cyst and mediastinal cyst. The patient has been operated for these three cysts with good recuperation on the psychiatric and neurological symptoms. He has been addressed in heart surgery for the heart localization. The hydatidose is an endemic illness in Morocco and constitute a public health problem. The cerebral localization is rare and appear by signs of cerebral hypertension and signs of focusing. The psychiatric demonstrations are rare but preserve a major interest, by the therapeutic measure specificity that they impose. Of course, the surgical ablation of the tumor can be sufficient to attenuate the psychiatric symptoms but the recourse to a specific treatment can prove to be necessary to act on the precise targets. We are conscious of the methodological difficulties that present these 2 cases but there are unfortunately due to the financial difficulties of our patients.

[New container of sample: role in the reduction of bacterial contamination of standard platelet units]

BACKGROUND

Bacterial contamination of unstable blood products constitutes today the most frequent infectious risk transmitted by blood transfusion. Platelet concentrates are often incrimineted. As responsible germs are in general of cutaneous origin, a sample procedure with diversion of the first 20 ml during blood donation is studied. The aim of this study is to evaluate the results of this technique on bacterial contamination rate of standard platelet units prepared at the regional blood transfusion center in Casablanca.

STUDY DESIGN AND METHODS

A comparative study of two types of sample pockets is made: 500 Standard Platelet concentrates (CPS) are prepared after collection using standard triple bags (Baxter) (group 1) and 560 pockets of CPS were prepared after collection using triple bags with Sample Diversion Pouch sampling system for elimination of the first 20 ml of donation (Macopharma and Terumo) (group 2). The skin was disinfected in two times with alcohol 70%. The bacteriological study was made in the two groups at the third day of conservation.

RESULTS

Six CPS of group 1 were contaminated, of which five were staphylococci coagulase negative and one bacillus sp. Six CPS of group 2 were contaminated, of which five were staphylococci coagulase negative and one staphylococcus aureus. The bacteria isolated were those of cutaneous flora at 100%. Diversion of first 20 ml of blood donation results in a 16.6% reduction in bacterial contamination of CPS (P>0.05).

CONCLUSION

The non-significant reduction in the prevalence of the bacterial infection of CP formulates the problem of the indication of the sampling devices with derivation of first 20 ml during blood collection.

Syndrome de stress post-traumatique chez les survivants du séisme d’Agadir (Maroc) de 1960

INTRODUCTION

Agadir City is geologically located on a seismic line. This city witnessed an earthquake in February 1960 with a magnitude of 6 degrees in Richter scale. During this disaster more than 17,000 people died and 60% of the town was destroyed.

OBJECTIVES

Forty years later, the objective of this study was to assess post-traumatic stress disorders at the time of the disaster and currently among this population.

METHODS

Two groups, matched by gender and age were included: 1) a group (G 1) of 80 earthquake survivors with an age varying from 45 to 70 years ; 2) a control group (G2) with 80 people who experienced accidental events other than the earthquake. The instruments used were: a questionnaire concerning socio-demographic data, and the Post-traumatic Stress Diagnosis Scale-Edna Foa-1995 for the diagnosis of PTSD which was translated in Moroccan Arabic language. The epidemiological survey was conducted in two steps during 13 months. The first step consisted in the inclusion of the first group: victims of the disaster. One hundred and two survivors were contacted and 80 accepted to participate in the study. The second step, concentrated on the inclusion of the other group, according to gender and age of the survivors group. All interviews were conducted in the homes of the participants. Data analysis was performed on a PC microcomputer using Epi info 6.04 French version (Center for disease control and prevention CDC, Atlanta, USA). The statistical analysis was based on the descriptive techniques of statistics.

RESULTS

The main results were: 1) after the traumatic events and retrospectively, survivors from the earthquake had statistically more PTSD than G2: 38.8% vs 20%; 2) at the time of the study, the prevalence of PTSD between the two groups was not significantly different: 10% for the survivors of the earthquake vs 7.5% for G2 (victims of accidents) while the dates of trauma differed; 3) forty years later, the socio-professional life of the survivors was still perturbed.

DISCUSSION

These results are in accordance with the literature, even if the methodological differences constitute a limiting factor for the comparison. Nevertheless, the persistence of symptoms of PTSD many years later might be explained by the severity of the trauma, the existence of external stimuli, such as the frequent tremors felt in Agadir, the noise, the storms, the earthquake happening in other cities...create a persistent state of hyper-vigilance which maintains and/or worsens the symptoms of PTSD.

CONCLUSION

In conclusion, 40 years later, survivors are in need of care to overcome symptoms of PTSD. Preventive measures for victims of disasters should perhaps be developed.