Diabetes mellitus and COVID-19: factors associated with bad prognosis

Diabetes is a risk factor for bad prognosis of COVID-19. Many mechanisms can explain the bad prognosis of COVID-19 in diabetics, but they remain hypothetical. The high prevalence of diabetes on the African continent, particularly in North Africa (12.2%), constitutes a threat of increased morbidity and mortality linked to COVID-19. We must pay particular attention to this fragile population, with more time and resources, especially for the elderly, obese or those with chronic complications of diabetes who have a high risk of developing severe forms

Management of Cardiovascular Risk among Moroccan Patients with Type 2 Diabetes: A Cross-Sectional Study

Objective: The aim of this study was to estimate the prevalence of cardiovascular disease and investigate cardiovascular risk management among type 2 diabetes (T2D) patients in the city of Meknes. Materials and methods: In a non-interventional cross-sectional study, we enrolled adult outpatients (≥ 18 years old) with T2D from the endocrinology anddiabetology consultation of the Military Hospital of Meknes from June 2021 to January 2022. Informed consent was signed by all participants in the study. Assessment of cardiovascular risk was based on European Society of Cardiology (ESC) Guidelines on cardiovascular disease prevention in clinical practice of 2021. Clinical, biological and therapeutic data were compared between patients with and without cardiovascular disease. Data were analyzed using SPSS version 18 statistical software. Results: One hundred eighty T2D patients were enrolled. The mean age was 59.42 ± 8.72 years. The prevalence of cardiovascular disease was 13.3%. The prescription of statin (p < 0.001), antihypertensive treatment (p < 0.001) and platelet aggregation inhibitors (p < 0.001) was significantly higher in patients with cardiovascular disease. Overall, 5.6% patients were prescribed a blood glucose-lowering agent with demonstrated cardiovascular benefit. This prescription was higher in patients with cardiovascular disease (5 (20.8%) vs. 5 (3.2%); p = 0.004). It was found that7.2% patients had an optimal cardiovascular risk factor management. Conclusions: The prevalence of cardiovascular disease among T2D patients is high in the city of Meknes. Despite an optimal prescription of cardiovascular medications,comprehensive control of cardiovascular risk factors is not achieved in most patients. The use of blood glucose-lowering agents with demonstrated cardiovascular benefit was low but significantly higher among patients with cardiovascular disease

Autoantibodies in Moroccan patients with type 1 diabetes: Which one to choose?

Background. Immunological investigations are intend-ed for diagnosing T1D in atypical clinical presentation, also exploring the predisposition to T1D in a context of multiple autoimmune disorders or among the siblings of a patient with type 1 diabetes. While the diagnosing or the screening of T1D using five antibodies presents high expenses especially in emerging countries, it is for interest to determine their prevalence in order to choose the most frequent and most relevant. The aim of our study is to determine the prevalence of antibodies in Moroccan population. Methods. We investigated 62 T1D patients, the prevalence of autoantibodies was 74% for glutamic acid decarboxylase 65 autoantibody (GADA), 46% for insulinoma-associated protein 2 autoantibody (IA2A), and 3% for islet cell antibodies (ICA). GADA and/or IA2A were reported in all patients (100%). The GADA frequency was neither associated with the duration of diabetes nor the age of patients. Results. Finally, GADAs are by far the best markers for T1D, IA2As complements GADAs and increases the diagnostic sensitivity for detection of pancreatic autoimmunity and ICA should be abandoned because of its low prevalence

L’impasse transfusionnelle

La présente étude a eu pour objectif d’apporter, le problème posé lors d’une impasse transfusionnelle due à la présence d’un anticorps antipublic. Le cas rapporté, porte l’anticorps anti-KEL2, qui est considéré comme un anticorps antipublic, vu la grande fréquence des personnes porteurs de l’antigène correspondant, plus de 99%. Le phénotype de ce sujet est obligatoirement K+k- (KEL : 1,-2) à cause de la codominance des allèles codants pour les antigènes KEL1, et KEL2. L’identification de ces anticorps passe par la recherche d’agglutinines irrégulières et l’épreuve directe de compatibilité. Les accidents transfusionnels qui en découlent sont variables, allant de la simple réaction fébrile, au choc hémolytique. Cette étude met l’accent sur les différentes alternatives préconisées ou en cours d’études. La recherche des poches de sang compatibles dans la banque de sang de phénotype rare, ou à travers le don dirigé par les membres de la famille, reste la première piste à envisager. Cependant d’autres alternatives ont prouvé leur efficacité, telle la transfusion autologue programmée. Les recherches dans ce domaine proposent des solutions, en cours d’essaie, qui mettent de l’espoir dans l’avenir transfusionnel de ces patients

Simultaneous Coexistence of Thyrotropin-Prolactin-Secreting Adenoma and Papillary Thyroid Carcinoma

Background. The thyrotropin-secreting adenomas are very rare and even more rare when they simultaneously coexist with thyroid carcinoma. So far, only sixteen cases have been reported in the literature. Here, we present a unique case of successful management of a concurrent case of thyrotropin-prolactinoma with papillary thyroid carcinoma. Case Presentation. A 50-year-old Moroccan woman underwent a total thyroidectomy and complementary totalization by iratherapy for papillary thyroid carcinoma, who presented persistence of an inappropriate secretion of the thyroid-stimulating hormone (TSH > 4 mUI/L) despite of levothyroxine suppressive therapy (300 μg/d). After eliminating noncompliance, interfering medicines, and thyroid malabsorption, a pituitary adenoma (12 mm) was documented at magnetic resonance imaging. The patient has had transsphenoidal pituitary adenomectomy with histology confirming a thyrotropin-prolactin-secreting adenoma. After surgery and lanreotide treatment failures, we noted a complete response (TSH < 0.5) with cabergoline treatment (3 mg/week). Conclusion. The unusual association of thyroid adenocarcinoma and TSHoma enriches the hypothesis of a potential link between thyrotropic hypersecretion and thyroid carcinogenesis. Our case also illustrates the difficulty of monitoring thyroid carcinoma in nonremission of a TSHoma

Cushing´s syndrome: high aggressiveness of low-grade tumors

Cushing´s syndrome is caused by prolonged exposition supraphysiological to endogenous or exogenous cortisol. Ectopic production of adrenocorticotropic hormone by lung carcinoid tumors is relatively rare. Most documented cases have been reported individually. This rare neoplasm low grade that may secrete adrenocorticotropin (ACTH) leading to rapid development of hypercortisolism which is the main mode of discovery, can be a real aggressive form. This report shows a high aggressiveness of this endocrine neoplasia, wich was marked on the general, morphological, bone and psychiatric level. The trivialization of clinical signs had caused the delay in diagnosis with irreparable bone consequences

Cukrzyca i COVID-19: źle rokujące połączenie

Cukrzyca jest czynnikiem ryzyka złego rokowania u pacjentów z COVID-19. Złe rokowanie w przypadku COVID-19 u chorych na cukrzycę może tłumaczyć wiele mechanizmów, ale pozostają one hipotetyczne. Wysoka częstość występowania cukrzycy na kontynencie afrykańskim, szczególnie w Afryce Północnej (12,2%), stanowi zagrożenie w postaci zwiększonej zachorowalności i umieralności chorych na COVID-19. Należy zwrócić szczególną uwagę na tę wrażliwą populację, poświęcić jej więcej czasu i środków, szczególnie w przypadku osób w starszym wieku, otyłych lub z przewlekłymi powikłaniami cukrzycy, u których istnieje wysokie ryzyko ciężkiego przebiegu COVID-19

Predicting malignancy of thyroid nodule using EU-TIRADS ultrasound score in an area of iodine deficiency

Background: In iodine-deficient region, thyroid nodules (TN) are more frequent and the proportion of benign nodules is higher compared to areas with sufficient iodine intake. Objective The aim of this study was to assess factors associated to malignant TN specially the Eu-TIRADS ultrasound score in a Moroccan population with high prevalence of iodine deficiency. Methods: In a prospective cross-sectional study, we enrolled outpatients referred for TN with Fine Needle Aspiration Biopsy (FNAB) indication according to EU-TIRADS 2017 classification. Malignancy of TN was defined by histological results indicating a thyroid malignancy on thyroid micro-biopsy or after surgical resection if indicated. Results: 225 TN were enrolled. The median of the patients’ age was 54 (42.5 ; 62) years-old. The prevalence of malignant TN was 8.9%. Malignant TN were significantly smaller than non-malignant ones (p = 0.008) and sub-centimetric TN were more frequent in malignant TN (25% vs 1.5%; p &lt; 0.001). On multivariate analysis, male gender (OR : 9.33 ; 95% CI [2.02 ; 43.01]; p = 0,004) and&nbsp; EU-TIRADS 5 score (OR : 55.6 ; 95% CI [9.34 ; 327.91] ; p &lt; 0.001) were independent factors associated with malignant TN. The EU-TIRADS 4 score was not associated to malignant TN. Conclusion Our data suggest a trend of over-diagnosing indolent thyroid cancer. The EU-TIRADS 4 score was not associated to TN malignancy. Considering clinical, accessory sonographic features and size threshold for FNAB in EU-TIRADS 4 score TN may refine the diagnosis performance of this score category in our population