Carbimazol and acenocoumarol, where is the problem?

Acenocoumarol and carbimazole are two drugs widely prescribed, they can sometimes be used in the same time. There is no known drug interaction between the two drugs but we report a case of a serious hemorrhagic complication following the concomitant use of the acenocoumarol and carbimazole. A 70-year old man treated by acenocoumarol for an aortic and mitral valve replacement. For a clinical and biological hyperthyroidism, he began treatment with carbimazole, ten days before admission. Three days later, he developed a mucocutaneous icterus with major hemorrhagic syndrome. The outcome was favourable after stopping medication and the use of vitamin K

Evaluation of selected trace elements in the Moroccan type 2 diabetic patients

Background: Several trace elements have been implicated in the etiology of type 2 diabetes, they can influence the onset or pathogenesis of diabetes in various ways including disruption of normal metabolism of glucose and insulin. The purpose of this work is to evaluate the serum status of copper, zinc, selenium, chromium and manganese in Moroccan type 2 diabetics compared to control group.Methods: Blood samples from 100 type 2 diabetics and 90 control subjects were analyzed for blood glucose, glycated hemoglobin (only for diabetics), lipid status and serum trace elements concentrations.Results: Glucose and triglyceride values were statistically higher in diabetics; while those of HDL-cholesterol were lower. Concentrations of zinc, selenium, chromium, and manganese were lower in diabetics compared to controls. In contrast, copper concentrations were higher.Conclusions: The status of trace elements is impaired in type 2 diabetics compared to a control group

Serum vitamin D and vitamin D receptor gene polymorphism in Moroccan patients with systemic lupus erythematosus

Background: Vitamin D plays an important role in the immunomodulation and could be involved in the development of autoimmune diseases such as systemic lupus erythematous (SLE). The study of the polymorphism of the Vitamin D Receptor (VDR) gene may be of interest in explaining the pathophysiology of SLE.Methods: In this study, we aimed to examine the characteristics of VDR gene BsmI polymorphism for the first time in Moroccan patients with SLE and their relationship with clinical manifestations of the disease. We also measured the serum level of 25-hyroxyvitamin D3 to assess its relation to such polymorphism.Results: The study included 66 SLE patients and 91 healthy controls. Our results showed that there were no differences observed in VDR genotypes and allelic distribution within the two groups. Both groups were in Hardy-Weinberg equilibrium, with no significant P values for the observed and expected genotype frequencies. 25-hyroxyvitamin D3 serum levels were the same in the two groups.Conclusions: Based on the results of the present study. We cannot verify any association between VDR gene BsmI polymorphism and SLE. This polymorphism could not be regarded as a genetic marker of the SLE. A larger study examining BsmI and other VDR gene polymorphisms is needed

Pancreatic cancer revealed by a Sister Mary Joseph’s nodule

Sister Mary Joseph´s nodule is a metastatic of a primary cancer, usually adenocarcinoma and associated with poor prognosis. Here we report the case of a 48-year-old man, admitted to the hospital with six months history of epigastric pain without vomiting or externalized hemorrhage and without transit disorders in a context of alteration of the general state with weight loss. Clinical examination showed epigastric sensitivity with a painful umbilical nodule, firm and irregular (A). Laboratory tests revealed a cholestasis. His computed tomography (CT) of the abdomen showed a mass lesion at the tail of the pancreas measuring 45 mm enclosing the splenic artery with secondary ganglionic, hepatic, bone and peritoneal localization (B, C). The umbilical lesion biopsies revealed metastasis of the pancreatic adenocarcinoma (D). The patient received palliative chemotherapy

Design and Rationale of the National Tunisian Registry of Heart Failure (NATURE-HF): Protocol for a Multicenter Registry Study

BackgroundThe frequency of heart failure (HF) in Tunisia is on the rise and has now become a public health concern. This is mainly due to an aging Tunisian population (Tunisia has one of the oldest populations in Africa as well as the highest life expectancy in the continent) and an increase in coronary artery disease and hypertension. However, no extensive data are available on demographic characteristics, prognosis, and quality of care of patients with HF in Tunisia (nor in North Africa). ObjectiveThe aim of this study was to analyze, follow, and evaluate patients with HF in a large nation-wide multicenter trial. MethodsA total of 1700 patients with HF diagnosed by the investigator will be included in the National Tunisian Registry of Heart Failure study (NATURE-HF). Patients must visit the cardiology clinic 1, 3, and 12 months after study inclusion. This follow-up is provided by the investigator. All data are collected via the DACIMA Clinical Suite web interface. ResultsAt the end of the study, we will note the occurrence of cardiovascular death (sudden death, coronary artery disease, refractory HF, stroke), death from any cause (cardiovascular and noncardiovascular), and the occurrence of a rehospitalization episode for an HF relapse during the follow-up period. Based on these data, we will evaluate the demographic characteristics of the study patients, the characteristics of pathological antecedents, and symptomatic and clinical features of HF. In addition, we will report the paraclinical examination findings such as the laboratory standard parameters and brain natriuretic peptides, electrocardiogram or 24-hour Holter monitoring, echocardiography, and coronarography. We will also provide a description of the therapeutic environment and therapeutic changes that occur during the 1-year follow-up of patients, adverse events following medical treatment and intervention during the 3- and 12-month follow-up, the evaluation of left ventricular ejection fraction during the 3- and 12-month follow-up, the overall rate of rehospitalization over the 1-year follow-up for an HF relapse, and the rate of rehospitalization during the first 3 months after inclusion into the study. ConclusionsThe NATURE-HF study will fill a significant gap in the dynamic landscape of HF care and research. It will provide unique and necessary data on the management and outcomes of patients with HF. This study will yield the largest contemporary longitudinal cohort of patients with HF in Tunisia. Trial RegistrationClinicalTrials.gov NCT03262675; https://clinicaltrials.gov/ct2/show/NCT03262675 International Registered Report Identifier (IRRID)DERR1-10.2196/1226