[Seizures revealing phosphocalcic metabolism abnormalities]

Hypocalcemia due to hypoparathyroidism produces a broad spectrum of clinical manifestations, but overt symptoms may be sparse. One unusual presentation is onset or aggravation of epilepsy in adolescence revealing hypoparathyroidism. This situation can lead to delayed diagnosis, with inefficacity of the antiepileptic drugs. We report five cases of adolescence-onset epilepsy with unsuccessful antiepileptic therapy, even with gradually increasing dose. Physical examination revealed signs of hypocalcemia, confirmed biologically. Full testing disclosed the origin of the seizures: hypoparathyroidism in three patients and pseudohypoparathyroidism in the other two. In four of five patients, computed tomography showed calcification of the basal ganglia, defining Fahr's syndrome. The patients were treated with oral calcium and active vitamin D (1-alphahydroxy vitamin D3). Seizure frequency progressively decreased and serum calcium levels returned to normal. These cases illustrate the importance of the physical examination and of routine serum calcium assay in patients with new-onset epileptic seizures in order to detect hypocalcemia secondary to hypoparathyroidism.

First report on the Moroccan registry of primary immunodeficiencies: 15 years of experience (1998-2012)

PURPOSE

Primary immunodeficiencies (PIDs) are a large group of diseases characterized by susceptibility to infections. We provide the first comprehensive report on PIDs in Morocco, the epidemiological, clinical, etiological and outcome features which have never before been described.

METHODS

A national registry was established in 2008, grouping together data for PID patients diagnosed since 1998.

RESULTS

In total, 421 patients were diagnosed between 1998 and 2012. Parental consanguinity was common (recorded for 43.2 % of patients) and the median time to diagnosis was 2.0 years. Overall, 27.4 % of patients were considered to have well defined syndromes with immunodeficiency (48 cases of hyper-IgE syndrome and 40 of ataxia-telangiectasia); 22.7 % had predominantly antibody deficiencies (29 cases of agammaglobulinemia and 24 of CVID); 20.6 % had combined immunodeficiencies (37 cases of SCID and 26 of MHC II deficiencies) and 17.5 % had phagocyte disorders (14 cases of SCN and 10 of CGD). The principal clinical signs were lower respiratory tract infections (60.8 %), skin infections (33.5 %) and candidiasis (26.1 %). Mortality reached 28.8 %, and only ten patients underwent bone marrow transplantation. We analyzed the impact on mortality of residence, family history, parental consanguinity, date of diagnosis and time to diagnosis, but only date of diagnosis had a significant effect.

CONCLUSIONS

The observed prevalence of PID was 0.81/100,000 inhabitants, suggesting considerable underdiagnosis and a need to increase awareness of these conditions in Morocco. The distribution of PIDs was different from that reported in Western countries, with a particularly high proportion of SCID, MHC II deficiencies, hyper-IgE syndrome and autosomal recessive agammaglobulinemia. However, we have now organized a national network, which should improve diagnosis rates in remote regions.

[Jaundice and urinary tract infection in neonates: simple coincidence or real consequence?]

In neonates, jaundice may be one of the initial symptoms related to urinary tract infection (UTI). The routine testing of the urine in jaundiced neonates is controversial. This study aimed to evaluate the related factors of neonatal infants with the initial presentation of hyperbilirubinemia and the final diagnosis of UTI by evaluating data that help diagnose UTI early in apparently healthy newborns with jaundice.

PATIENTS AND METHODS

We retrospectively investigated the medical records of neonates who had been admitted for management of jaundice (n=26) and compared with neonates with jaundice but without UTI (n=26).

RESULTS

There was a significant difference between the two groups in male gender and maternal conditions (prolonged rupture of membranes, maternal UTI). There was also a significant difference between the two groups in their age at the time jaundice started (4 ± 3 days vs 2 ± 1 days) in the UTI and non-UTI groups, respectively (P>0.05). The cases in the UTI group had significantly lower total bilirubin levels (183 ± 71 mg/l) vs (227 ± 40 mg/l) in the non-UTI group, but a higher indirect bilirubin rate than the non-UTI group (P<0.05). Type B blood group was more common in neonates with UTI (P<0.01). In the cases presented herein, none of the jaundiced infants with UTI presented conjugated hyperbilirubinemia. Therefore, urinary tests for UTI should not be absolutely excluded or neglected in neonates in the early stage with unconjugated hyperbilirubinemia. Performing urinary tests to exclude the possibility of coincidental UTI may be necessary for admitted jaundiced infants younger than if they have a high level of indirect bilirubin, especially in male newborns with group B blood and in the presence of maternal urinary infection.

Repair of isolated double-chambered right ventricle

The finding of a double-chambered right ventricle (DCRV) is exceptionally rare as an isolated anomaly. It is a congenital cardiac anomaly in which the right ventricle is separated into two chambers, a proximal high-pressure chamber and a distal low-pressure chamber, by anomalous muscles or fibrous tissues in the right ventricular cavity. We report the case of a 6-year-old infant who was admitted for growth retardation. The patient was diagnosed with an isolated DCRV without any other associated congenital anomalies. The patient underwent a successful cardiac surgical procedure of enlargement repair; he was discharged in good clinical condition with a normal cardiac function.

[Primary familial erythromelalgia. A case report]

Erythromelalgia is a rare disease whose etiology is poorly understood. It is characterized by paroxysmal attacks of erythema, pain, and warmth of the extremities and can be primary or secondary. We report a case of primary familial erythromelalgia and stress the difficulties in its therapeutic management. We provide a brief update on the pathophysiology and treatment of primary erythromelalgia.

[Foreign body ingestion in children: 105 case reports]

The ingestion of a foreign body (FB) is one of the most frequent childhood accidents requiring urgent care depending on the type and localization. Coins are the most frequent, and disk battery ingestion can lead to a significant risk of complications. FB stagnation in the esophagus entails a major risk of perforation. This article reports a retrospective study of 105 cases of foreign body ingestion admitted to the pediatric gastroenterology unit between November 2002 and June 2010. The average age of these patients was 4 years with a 1.5 sex ratio. Ten patients were followed for esophagus stenosis; the others had no considerable pathological histories. The fibroscopy performed on 104 patients allowed us to visualize the foreign body in 96 cases (91.4%). In the 8 remaining cases, the FB was not found (it had already migrated in the digestive tract). Coins were the most frequent (64.7%). Endoscopic extraction removed 83 FBs (86.4%). In 11 cases, it was pushed towards the stomach, split up in 1 case, and surgery was necessary in only 1 case. The progress of child digestive fibroscopy has decreased both the morbidity related to the ingestion of foreign bodies and the use of surgery. Prevention should be based on educating the parents by informing them about the risk of this kind of accident.