Background: The SARS-CoV-2 coronavirus, has been identified since 2019, as the causative agent of a new respiratory disease called the COVID-19 (Coronavirus Disease 2019). Numerous risk factors for COVID-19 severity have been described, but data on infected patients in North Africa are limited. We aimed to explore the predictive factors of disease severity in COVID-19 patients in the pneumology department of the Mohammed VI Hospital in Marrakech. Methods: A descriptive and analytical cross-sectional study conducted among patients hospitalized for COVID- 19 during the period from October 2020 to December 2020 in intensive care unit CHU Mohammed VI of Marrakech confirmed and presenting acute respiratory distress. The variables retained in the final model were selected using a stepwise forward method with an entry threshold at 0.2 and an exit threshold at 0.05. The significance threshold was retained for p <0,05. The descriptive analysis consisted of the calculation of absolute and relative frequencies for the qualitative variables, and of the positioning and dispersion parameters for the quantitative variables (mean, standard deviation). For the comparison of percentages in bivariate analysis, Pearson's Chi2 statistical test and Fisher's test if necessary were used. Results: 125 cases of COVID-19 were collected (40.8 women and 59.2 men). The average age was 59.6 years (26-90). 86.4% were exposed to tobacco. 66.7% were active smokers and 33.3% were passive smokers. The presence of comorbidities was noted in 77.6% of cases. These were arterial hypertension (28.4%), diabetes (32.6%), heart disease (7.1%), neoplasia (5.7%), dysthyroidism (5.7%) and bronchial asthma (6.4%). Confirmatory examinations included suggestive imaging in 76.9%, 47.9% a positive pcr. The predominant respiratory symptoms were cough in 84% of cases, followed by dyspnea in 70.9% of cases. The predominant extra-respiratory signs were asthenia in 79% of cases, followed by myalgia in 46% of cases, ......

Hungry bone syndrome is a rare but potentially lethal complication that is characterized by rapid, severe, long-lasting hypocalcemia and hypophosphatemia secondary to increased bone metabolism. Hereby, we present a case of a 38-year-old patient who received a kidney transplant 09 months after a subtotal parathyroidectomy. She developed severe hypocalcemia and hypophosphatemia 15 days after renal transplant and required high-dose of calcium for 4 months thereafter. The aim of this case report is to highlight and raise awareness for the importance of strict nutritional and electrolyte management in the post transplantation period. A prompt diagnosis and correction of hungry bone syndrome are imperative to prevent the associated significant morbidity and mortality [1].

Primary pancreatic lymphomas (PPLs) are rare cancers that have a complicated histological classification. Sufficient sample volumes are required to adequately diagnose and decide the best treatment for PPLs. A 54-year-old man with primary pancreatic mantle cell lymphoma is described in this case study. Percutaneous biopsy was used to extract histological samples. Atypical small to medium round cells predominated in the tumor cells, which had diffuse CD20 and cyclin D1 positivity. Chemotherapy was used on the patient, and he went into complete remission as a result. Because it provides adequate samples for testing, a percutaneous biopsy could be a valuable and safe diagnostic tool for PPLs.

Introduction: Extra pulmonary TB is caused by dissemination of primary infection through blood and lymph to neighbouring regions like pleura, lymph nodes, bones and joints, where they remain dormant. Reactivation of the disease is caused by disorders of immune system. Skeletal TB consists of 2% of all TB cases and 10-35% of extrapulmonary TB cases. Skeletal TB in humerus are a rare occurrence accounting upto 1-2% of total skeletal TB cases. Here we present a case of proximal humerus tuberculosis which was misdiagnosed and treated as rotator cuff injury by local practitioners and adviced physiotherapy. Case report: The patient is a 16 years old female with humeral head osteomyelitis at bone tendon interface with biceps tendon involvement. We managed the case with MRI followed by CT guided biopsy and anti tubercular regimen was started based on histopathology reports. Patient had resolution of infection with good range of shoulder mobility and satisfactory function. Conclusion: The diagnosis of proximal humerus TB is clinically challenging due to confluence of nonspecific symptoms and X ray findings which misguides clinicians to misdiagnose it as rotator cuff pathology, frozen shoulder, pyogenic osteomyelitis or tumours. This leads to delay in treatment. Probability of skeletal TB should always be kept in mind in such cases, especially in endemic countries which will help in timely diagnosis and treatment.

A 70-yr-old covid positive male patient who presented with cough and shortness of breath, upon CT chest found to have features typical of COVID-19 infection and a small mass arising in left 8th rib. A histopathological examination of the mass found to be osseous plasmacytoma, after a PET scan it was confirmed to be a solitary lesion. Bone marrow aspiration cytology showed normal plasma cell count, thus, diagnosed as solitary Plasmacytoma of bone. There was no negative impact on the recovery of the patient by COVID-19 due to solitary Plasmacytoma.

Acute severe pain is the most common condition for emergency consultations. opioids are the cornerstone of the treatment. However, they expose to various adverse effects. We describe a case of a 22-year-old woman with severe pain to her right hand, after a domestic fall, successfully managed by nebulized ketamine. Ketamine administration via nebulized route might be an attractive and non-invasive alternative to opioids use in acute pain management.

Introduction: Extra skeletal myxoid chondrosarcoma is a rare soft tissue tumor. It is a low-grade sarcoma, arising mainly in the deep tissues and musculature of the extremities, with a histological resemblance to its bony counterpart. It accounts for less than 3% of soft tissue sarcomas, and localizes mainly in the upper extremity, shoulder, neck, orbit but also intra-abdominally. It is a tumor with a high metastatic potential and an unfavorable long-term prognosis. Extra skeletal myxoid chondrosarcoma is a tumor occurring in middle-aged patients regardless of gender or race. Treatment is multimodal including surgery, radiation therapy and chemotherapy. Case presentation: A 37-year-old female patient consulted for a subcutaneous swelling on the sole of the left foot opposite the 5th toe; evolving for approximately six years. The clinical examination and the paraclinical work-up revealed a mass that encompassed the diaphysis of the 5th metatarsal with cortical lysis opposite. This mass arrived medially at the contact of the 4th metatarsal without cortical lysis. The extension work-up was unremarkable. The histological, immunohistochemical and molecular biology examination of the surgical biopsy concluded to an extra skeletal myxoid chondrosarcoma. Polychemotherapy with andriamycin and Ifosfamide, surgery and radiotherapy at a dose of 50Gy was performed. Conclusion: Rare tumor and of difficult diagnosis, the key of the diagnosis lies in molecular biology. Survival is often prolonged despite its local aggressiveness.

ERCP is the most commonly used technique to treat biliary stenosis of benign or malignant origin. Duodenal perforations secondary to biliary prostheses are very rare but can be life threatening. Endoscopic retrograde cholangiopancreatography (ERCP) plays an important diagnostic and therapeutic role in the management of biliary and pancreatic disorders. However, it is an invasive procedure with an associated complication rate in the vicinity and mortality. Therapeutic strategies are multiple. We present an unusual case of a patient who sustained a stent-related duodenal perforation after undergoing ERCP whose prognosis was poor.

Left small colon syndrome is a rare cause of neonatal obstruction, favored by the existence of a diabetic mother in 40 to 50% of cases. The diagnosis is evoked by ultrasound and confirmed by an opaque enema with water-solubles. The enema will allow a colonic emptying often accelerating the regression of the digestive symptoms (use of gastrografine if necessary). The prognosis is good with symptomatic and conservative treatment. The meconium plug syndrome can also be compared to this condition, which is also part of the functional occlusive syndromes that resolve.

Post-traumatic adrenal hematoma is a difficult to diagnose condition with rare but severe complications. Post-traumatic adrenal hematoma occurs in up to 2% of patients with abdominal trauma. Only CT scans performed during lesion assessments of violent thoracoabdominal trauma can confirm the diagnosis. Symptomatology is often masked by associated visceral or parietal injuries. Standard biological examinations are generally of little help. We describe a case of a 12-year-old child who presented with a right adrenal hematoma after a road traffic accident (MVA), associated with a peritoneal effusion and a fracture of the right sacral fin as well as a fracture of the right pubic ischium.

Spontaneous coronary artery dissection (SCAD) has long been recognized as a cause of acute coronary syndromes (ACS) with very low prevalence (3% in most cohorts). It predominantly occurs in young to middle-aged women. SCAD patients have fewer traditional cardiovascular risk factors for ischaemic heart disease than patients with atherosclerotic coronary artery disease, however, many patients do have some risk factors for ischaemic heart disease including hypertension, smoking, and dyslipidaemia, although there is no evidence these contribute directly to the risk of SCAD. We report in this case an observation of spontaneous coronary dissection, in order to discuss its pathogenesis, diagnosis and management.

Restlessness occurs during cluster headache attacks and in response to painful stimuli that feel like stemming from an escapable source. Animal experiments show that being repeatedly subjected to restlessness-causing painful stimuli may result in learned helplessness, characterized by passivity and fear in response to pain, and potentially depression. This article reports a patient suffering from chronic cluster headache, whose ictal behaviour had transitioned from restlessness to quiescence and who felt intense fear at the beginning of each attack. We argue that this change may be due to learned helplessness and discuss implications. Learned helplessness might contribute towards a comorbid depression. It should be suspected when the ictal behaviour transitions from restlessness to quiescence, and patients report ictal fear.

Bladder lithiasis refers to the disease associated with the formation of stones in the bladder. These stones, which can reach several centimetres in size, are formed from aggregates of various mineral and organic substances. Most often these stones are formed as a result of poor bladder evacuation. We report a case of bladder macrolithiasis associated with two stones: right ureteral and renal on bladder neck stenosis revealed by hypogastric pain and signs of lower urinary tract and complicated by renal failure in a 42 year old patient. The physical examination revealed bilateral lumbar tenderness and a hard hypogastric palpable mass. Imaging revealed the presence of a bladder macrolithiasis occluding almost the entire bladder associated with a pelvic ureter stone and a right renal corraliform stone. The treatment consisted of a suprapubic cystotomy with extraction of the macro bladder stone and the ureteral stone delivered through the meatus by ureterolithotomy with cervical incision of the bladder neck. The postoperative course was simple. The evolution was marked by the normalization of the renal function. The patient underwent a lumbotomy for his right kidney stone 2 months later.