Myxome de la petite valve mitrale: à propos d’un cas

Les myxomes cardiaques constituent les formes les plus fréquentes des tumeurs primitives du coeur. La localisation la plus fréquente est le septum interatrial et exceptionnellement au niveau des valves cardiaques. L'exérèse chirurgicale est la seule alternative thérapeutique. Nous rapportons l'observation clinique d'un patient âgé de 69 ans, sans antécédents pathologique notables, qui a présenté une dyspnée stade II à III de la NYHA associée à une lipothymie. L'échocardiographie transthoracique a objectivé un rétrécissement aortique calcifié serré avec un gradient moyen VGaorte à 58 mmHg. Au niveau de la valve mitrale présence d'une masse de 15mm de diamètre, s'insérant sur la petite valve mitrale sessile, sans effet de sténose ni de fuite mitrale évoquant un myxome de localisation atypique ou un fibroélastome. L'examen a été complété par une ETO qui a confirmé le diagnostic de la masse de la petite valve mitrale. Le patient est opéré avec une stérnotomie médiane verticale, et sous circulation extracorporelle conventionnelle. Une atriotomie gauche a permis d'objectiver une masse sessile de 15mm de diamètre sur la face auriculaire de la petite valve mitrale, friable et facilement clivable. Le geste a été complété par une cautérisation de la base d'implantation au bistouri électrique sans geste supplémentaire sur la petite valve mitrale. La pièce opératoire est adressée en anatomo-pathologie qui a confirmé le diagnostic de myxome. Le patient a bénéficié aussi d'un remplacement valvulaire aortique par prothèse mécanique. Les suites opératoires immédiates étaient simples. Le patient a quitté le service à J8 postopératoire. La localisation mitrale du myxome cardiaque est très rare. Le traitement chirurgical reste la seule option thérapeutique avec une résection la plus large possible pour éviter tout risque de récidive

Persistance du 5ème arc aortique associé à une interruption de l’arche aortique

Les auteurs rapportent un cas de persistance du 5ème arc aortique associé à une interruption totale de l'arche aortique. Ce cas clinique montre le piège diagnostic posé par la persistance du 5ème arc aortique et son effet bénéfique hémodynamique. Le tableau clinique était trompeur en préopératoire en raison de la persistance des pouls fémoraux et des signes cliniques d'un shunt gauche-droite via un large canal artériel. Le diagnostic a été redressé en peropératoire grâce au monitorage de la pression artérielle par un cathéter placé dans l'artère fémorale

Syndrome CHARGE avec tétralogie de Fallot: à propos d’un cas

Le syndrome CHARGE est caractérisé par un large polymorphisme clinique associant colobome, anomalies cardiaques, atrésie de choanes, retard staturo-pondéral et de développement, anomalies génitales, anomalies des oreilles ainsi que d'autres anomalies. Les auteurs rapportent le cas d'un syndrome CHARGE diagnostiqué lors du bilan d'une tétralogie de Fallot chez un nourrisson de 22 mois. Les différentes manifestations cliniques de ce syndrome sont rapportées ainsi que les critères diagnostiques

The CYP7A1 gene rs3808607 variant is associated with susceptibility of tuberculosis in Moroccan population

Introduction: Despite the medical progress in treatment. Tuberculosis (TB) continues to be a serious global health problem. A genome-wide linkage study identified a major susceptibility locus on  chromosomal region 8q12-q13 in Moroccan TB patients. The CYP7A1 gene is located in this region and codes for cholesterol 7a-hydroxylase, an enzyme involved in cholesterol catabolism. Methods: We selected three SNPs (rs3808607, rs8192875 and rs8192879) and studied their genotype and allele frequencies distribution in patients with pulmonary (PTB) or pleural TB (pTB), and compared them to Healthy Controls (HC). Genotyping of rs8192875 and rs8192879 SNPs was carried out using the Taq Man SNP genotyping Assay while rs3808607 was investigated by PCR-RFLP.Results: We reported here for the first time a statistically significant increase in the AA homozygote genotype frequency of rs3808607 in PTB patients compared to HC (p = 0.02, OR = 1.93, 95% CI: 1.93 (1.07;3.49). The increased risk of developing TB was maintained when we combined the groups of patients (PTB-pTB) (p = 0.01, OR= 1.91, 95% CI = (1.07 - 3.42). In contrast, no genetic association was observed between the rs8192875 or rs8192879 polymorphisms and TB. Conclusion: Our investigations suggest that rs3808607 may play a role in susceptibility to TB in a Moroccan population.Key words: Tuberculosis, cholesterol 7-alpha-hydroxylase, polymorphisms, SNPs, cholestero

Early results for active infective endocarditis

Introduction: Cardiac surgery is frequently needed during active phase of infective endocarditis (IE). The purpose of this study was to analyze the immediate and late results and determine the risk factors for death.Methods: We retrospectively reviewed 101 patients with IE operated in the active phase. The mean age was 40.5 ± 12.5 years. 16 patients (15.8%) were diagnosed with prosthetic valve endocarditis (PVE). 81 (80.9%) were in NYHA functional class III-IV. Blood cultures were positive in only 24 cases (23.9%).Results: in-hospital mortality rate was 17.9% (18 cases). Multivariate analysis indentified five determinant predictor factors: congestive heart failure (CHF), renal insufficiency, high Euroscore, prolonged cardiopulmonary bypass time (> 120 min) and long ICU stay. The median follow-up period was 4.2 (2-6.5) years. Overall survival rate for all patients who survived surgery was 97% at 5 years and 91% at 10 years.Conclusion: Despite high in-hospital mortality rate, when patients receive operation early in the active phase of their illness, late outcome may be good.Keywords: Infective endocarditis, valvular surgery, active phas

Use of magnetic resonance imaging in assessment of constrictive pericarditis: a Moroccan center experience

<p>Abstract</p> <p>Background</p> <p>The diagnosis of constrictive pericarditis continues to be a clinical challenge. Magnetic resonance imaging provides excellent visualization of the pericardium. The aim of our study is to clarify the contribution of this non invasive exploration in the diagnosis of constrictive pericarditis in our center.</p> <p>Methods</p> <p>we conducted a prospective study over a period of two years, since 2008, covering a series of patients (n = 11), mean age 44 ± 15 years, in whom constrictive pericarditis was suspected clinically and on transthoracic echocardiography. We studied its characteristics on magnetic resonance imaging.</p> <p>Results</p> <p>Magnetic resonance imaging confirmed the diagnosis showing pericardial thickening in all cases, measuring 8.2 +/- 2.6 mm on average, circumferential in 64%, and localized in 36%. The imaging data, particularly pericardial thickening and its topography, were confirmed by surgical exploration, and results were concordant in all cases.</p> <p>Conclusion</p> <p>Magnetic resonance imaging is a powerful tool to establish constrictive pericarditis diagnosis.</p

Key Concepts of Psychotherapy on the Basis of Play Therapy

Effect of Allium sativum extract on human PBMC proliferation. CD4 T cell division was evaluated by CFSE staining and flow cytometry when PBMCs were treated with or without A.S. at two different doses in the absence or presence of PHA (a) or Okt-3 mAb (b). CD8 T cell division assessed by CFSE staining and flux cytometry within PBMCs treated with or without A.S. at two doses in the absence or presence of PHA (c) or Okt-3 mAb (d). Data shown are representative of 4 independent experiments. Percentage of cell division was calculated with FlowJo software. Data are represented in mean ± S.D. and were analyzed using the one-way ANOVA test. (DOCX 278 kb

Current use and acceptability of novel diagnostic tests for active tuberculosis : a worldwide survey

CITATION: Amicosante, M., et al. 2017. Current use and acceptability of novel diagnostic tests for active tuberculosis : a worldwide survey. Jornal Brasileiro de Pneumologia, 43(5):380-392, doi:10.1590/S1806-37562017000000219.The original publication is available at http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132017000500380&lng=en&tlng=enObjective: To determine the current use and potential acceptance (by tuberculosis experts worldwide) of novel rapid tests for the diagnosis of tuberculosis that are in line with World Health Organization target product profiles. Methods: A multilingual survey was disseminated online between July and November of 2016. Results: A total of 723 individuals from 114 countries responded to the survey. Smear microscopy was the most commonly used rapid tuberculosis test (available to 90.9% of the respondents), followed by molecular assays (available to 70.7%). Only a small proportion of the respondents in middle- and low-income countries had access to interferon-gamma-release assays. Serological and lateral flow immunoassays were used by more than a quarter (25.4%) of the respondents. Among the respondents who had access to molecular tests, 46.7% were using the Xpert assay overall, that proportion being higher in lower middle-income countries (55.6%) and low-income countries (76.6%). The data also suggest that there was some alignment of pricing for molecular assays. Respondents stated they would accept novel rapid tuberculosis tests if available, including molecular assays (acceptable to 86.0%) or biomarker-based serological assays (acceptable to 81.7%). Simple biomarker-based assays were more commonly deemed acceptable in middle- and lowincome countries. Conclusions: Second-generation molecular assays have become more widely available in high- and low-resource settings. However, the development of novel rapid tuberculosis tests continues to be considered important by tuberculosis experts. Our data also underscore the need for additional training and education of end users.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132017000500380Publisher's versio

Insights into the T-cell response to SARS-CoV-2

Following infection with SARS-CoV-2, cellular components of the adaptive immune system play a crucial role in eliminating the virus. Specifically, virus-specific CD4+ and CD8+ T cells generate effector cytokines and display cytotoxic activity. A number of studies carried out during the COVID-19 pandemic highlighted the importance of CD4+ T cells, CD8+ T cells, and memory cells in this process. T-cell responses emerge early and contribute to protection, but are comparatively impaired in severe cases, often accompanied by intense activation or lymphopenia. Since December 2020, SARS-CoV-2 vaccines have been licensed and administered worldwide. These vaccines induce a targeted T-cell response against SARS-CoV-2. The cellular response after the third dose was strong and superior to that obtained with the second dose. COVID-19 multiple vaccines elicit a robust CD4+ and CD8+ T cell response after the short-term booster. While, the T-cell response induced by COVID-19 vaccines has been shown to decline within 6-12 months of vaccination. In addition, the long-term persistence of cellular immunity may protect against the development of severe disease. In addition, adoptive T-cell therapies have shown considerable potential in the development of COVID-19 traitement. These therapies involve the transfer of T cells with specific antiviral properties into patients to boost their immune response against SARS-CoV-2