An unusual manifestation of hyperkalemia

An 82 years old patient was admitted to the emergency department complaining since 15 days of fatigue, dizziness and lipothymia. He had a history of hypertension and diabetes; and had undergone a coronary bypass in 2005. His physical examination showed a blood pressure at 160/50mmHg, a heart rate at 26cycles/min, and he was afebrile. On admission the ECG showed a third degree atrioventricular bloc with a regular rhythm at 26 cycles/min, P wave was absent, QRS complex was not wide (<0.10ms) and the T wave was not “tente like”, tall, peaked and symmetric, it was negative in the inferior territory and the ST segment was underlined in the laterobasal derivations. The laboratory findings included a serum potassium level of 6.9mEq/l (normal 3.6-5.5), sodium 132mEq/l (normal 135-140), creatinine 30mg/l (6-14) and urea nitrogen 0.82g/l (0.17-0.43), MDRD clearance was at 20ml/min (normal>80). The arterial blood gas analysis revealed a pH of 7.32, pO2=115mmHg, and pCO2=34mmHg. The patient was treated immediately with furosemide, bicarbonate serum, calcium gluconate, glucose solution, and insulin, after three hours, the ECG showed normal sinus rhythm with visible P waves, a heart rate at 60cycles/min and a shortening of the QT interval in comparison with the first ECG. Blood potassium at this moment was at 5.60mEq/l. Hyperkalemia is known to cause a depression of the conduction velocity and excitability of the pacemaker cells and conduction tissues, resulting generaly in an advanced atrioventricular bloc with wide QRS complex. In this case the QRS remained normal

Communication interventriculaire post infarctus du myocarde: à propos d’un cas et revue de la litterature

La rupture septale secondaire à l'infarctus du myocarde est une complication aiguë redoutable dont la mortalité est non négligeable à la phase précoce. Nous rapportons le cas d'une rupture septale apicale chez un patient de 70 ans admis aux urgences pour prise en charge d'un post infarctus de myocarde antéro-septal. C'est une urgence extrême dont la prise en charge doit être multidisciplinaire. Nous mettons le point sur les facteurs de risque et sur le traitement à proposer pour ce type de complication.Mots clés: Infarctus du myocarde, communication interventriculaire, MarocEnglish Title: Interventricular defect after myocardial infarction: about a case and literature reviewEnglish AbstractVentricular septal rupture (VSR) after myocardial infarction is a fearsome acute complication whose mortality is not negligible in the early phase. We report the case of a 70-year old patient with apical septal rupture admitted to the Emergency Department with ventricular septal rupture after anteroseptal myocardial infarction. This disease is of the utmost urgency, so its management should be multidisciplinary. This study aims to focus on the risk factors and the treatment of this complication.Keywords: Myocardial infarction, inter-ventricular communication, Morocc

UNCOVERING HIDDEN INSIGHTS: WHEN ABDOMINAL PAIN LEADS TO THE DISCOVERY OF RENAL INFARCTION

Renal infarction is a rare event that is often overlooked in emergency departments. Despite the contribution of imaging, diagnosis remains a delicate matterdue to the variety of clinical presentations. We describe a case of right flank pain revealing this entity

Complication rare et grave de la rachianesthésie: la méningite bactérienne (à propos d’un cas et revue de la littérature)

La rachianesthésie (RA) est la première anesthésie locorégionale. Elle comporte des effets secondaires et des risques qu'il faut pouvoir éviter, prévenir ou traiter précocement. C'est le cas d'une patiente opérée sous rachianesthésie qui a présenté quelques jours après l'interventionde céphalées intenses associées à des nausées et des vomissements évoluant dans un contexte de fièvre. La ponction lombaire mettait en évidence un liquide trouble avec la présence de cocci gram + à l'examen direct, ce qui a permis de poser le diagnostic d'une méningite bactérienne et dont l'évolution a été favorable après antibiothérapie.Mots clés: Méningite bactérienne, rachianesthésie, nosocomiale, complication grave, asepsieEnglish Title: Rare and severe complication of spinal anesthesia: bacterial meningitis (about a case and literature review)English AbstractSpinal anesthesia (SA) is the first locoregional anesthesia. It can cause side effects and carry risks that need to be avoided, prevented or treated early. We here report the case of a female patient operated under spinal anesthesia who had intense headache associated with nausea and vomiting evolving in the context of fever within a few days after surgeryLumbar puncture showed cloudy liquid revealing Gram + cocci on direct examination. This allowed the diagnosis of bacterial meningitis. Patient’s evolution was favorable after antibiotic therapy.Keywords: Bacterial meningitis, spinal anesthesia, nosocomial, serious complication, asepsi

Spinal hydatidosis mimicking Guillain Barre syndrome: in case of doubt there is no rush to perform lumbar puncture

Guillain Barre Syndrome (GBS) is a challenging pathology which diagnosis is based essentially on the clinical examination and the results of lumbar puncture. Differential diagnosis must be discussed if the clinical picture is not complete. We present the case of a patient who presented to the emergency department with symptoms evoking both GBS and spinal cord compression. The Radiology showed a diffused spinal hydatidosis. The lumbar puncture must be carefully considered. In this case, it would have exposed the patient to hydatid dissemination

Thrombolysis for acute ischemic stroke by tenecteplase in the emergency department of a Moroccan hospital

Introduction: Thrombolysis has radically changed the prognosis of acute ischemic stroke. Tenecteplase is a modified form of rt-PA with greater specificity for fibrin and a longer half-life. We report the experience of a Moroccan tertiary hospital in thrombolysis using Tenecteplase. Methods: We conducted an open prospective study of all patients who were treated with Tenecteplase for an acute ischemic stroke admitted to our emergency department. Tenecteplase was administered intravenously at a dose of 0.4 mg/kg single bolus. The primary outcome measure was the proportion of patients achieving significant early neurological recovery defined as an improvement of 4 or more points on the NIHSS score at 24h. Results: 13 patients had been treated by intravenous thrombolysis. 31% were women. Mean age was 63 years old. The mean NIHSS score at admission was 14.3 and 24h after was at 9.1. The right middle cerebral artery was involved in 69% of cases. The carotid atherosclerosis was predominant 63.3% and the cardio embolic etiology 27%. The mean time to the first medical contact after the onset of symptoms was 3h 30 min. One patient presented a capsulo-lenticular hematoma of 5 mm3 in the same side of the ischemic stroke. Conclusion: Tenecteplase is a more interesting thrombolytic than alteplase, it seems to be more suitable for thrombolysis in our center.Keywords: Acute ischemic stroke, thrombolysis, tenecteplas

Hydatid cyst of the pericardium: a case report

Pericardial hydatid cystis a rare condition; its clinical presentation is variable. It can reveal straightaway at the stage of life threatening complications. We report the case of a 17 years old female Arab patient, who complained of as udden on set dyspnea, clinical examination was poor; the diagnosis was suspected by echocardiography and confirmed by the CT scan and hydatid serology. Furthermore, no other location was noted. Surgical treatmentwas proposed. The modern cross-sectional imaging especially CT scan and MRI revolutionized the diagnosis of this rare hydatid location

Acinetobacter infections prevalence and frequency of the antibiotics resistance: comparative study of intensive care units versus other hospital units

Introduction: This study aims to determine the Acinetobacter sp clinical isolates frequency and its antibiotic susceptibility pattern by comparing results obtained from the Intensive Care Units (ICUs) to that of other units at the Mohammed V Military Teaching Hospital in Rabat. Methods: This is a retrospective study over a 2-years period where we collected all clinical isolates of Acinetobacter sp obtained from samples for infection diagnosis performed on hospitalized patients between 2012 to 2014. Results: During the study period, 441 clinical and non-repetitive isolates of Acinetobacter sp were collected representing 6.94% of all bacterial clinical isolates (n=6352) and 9.6% of Gram negative rods (n=4569). More than a half of the isolates were from the ICUs and were obtained from 293 infected patients of which 65, 2% (191 cases) were males (sex ratio = 1.9) and the median age was 56 years (interquartile range: 42-68 years). Acinetobacter clinical isolates were obtained from respiratory samples (44.67%) followed by blood cultures (14.51%). The resistance to ciprofloxacin, ceftazidime, piperacillin / tazobactam, imipenem, amikacin, tobramycin, netilmicin, rifampicin and colistin was respectively 87%, 86%, 79%, 76%; 52%, 43%, 33% 32% and 1.7%. The difference in resistance between the ICUs and the other units was statistically significant (p <0.05) except for colistin, tetracycline and rifampicin. Conclusion: This paper shows that solving the problem of prevalence and high rate of multidrug resistant Acinetobacter infection which represents a therapeutic impasse, requires the control of the hospital environment and optimizing hands hygiene and antibiotics use in the hospital.Pan African Medical Journal 2016; 2

A year of genomic surveillance reveals how the SARS-CoV-2 pandemic unfolded in Africa.

The progression of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in Africa has so far been heterogeneous, and the full impact is not yet well understood. In this study, we describe the genomic epidemiology using a dataset of 8746 genomes from 33 African countries and two overseas territories. We show that the epidemics in most countries were initiated by importations predominantly from Europe, which diminished after the early introduction of international travel restrictions. As the pandemic progressed, ongoing transmission in many countries and increasing mobility led to the emergence and spread within the continent of many variants of concern and interest, such as B.1.351, B.1.525, A.23.1, and C.1.1. Although distorted by low sampling numbers and blind spots, the findings highlight that Africa must not be left behind in the global pandemic response, otherwise it could become a source for new variants

Conservative treatment of a psoas hematoma revealed by a lower limb palsy

The psoas hematoma is a rare complication of the anticoagulation therapy. It cause abdominal or lumbar pain, muscle dysfunction and sometimes nerve palsy. The optimal treatment is not well established, surgery or conservative treatment? We report here a case of psoas hematoma revealed by a lower limb palsy