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Neuro-endocrine disorders are a frequent complication of head trauma. The exploration of these disturbances is important because it can contribute to the understanding of some symptoms presented by the patients for better management in the acute phase or during the evolution. Aim: The objective of this study was to identify the anterior pituitary dysfunction of severe traumatic brain injury and to analyze the correlations between these disorders, brain lesions and clinical signs. Materials and Methods: This is a prospective and descriptive study, conducted in collaboration between the pediatric intensive care unit and the clinical biochemistry laboratory of the Mohammed VI University Hospital of Marrakech. This study was spread over 9 months. It Included children admitted for severe head trauma and with a clinical, hormonal and CT scan. And the interest was in 28 severely traumatized skulls in the acute phase. All patients received TSH, T3, T4, Prolactin and cortisol levels 8 hours after admission. Results: There were twenty eight patients included in the study. Sex ratio m / f of 1.54, whose age varies between 9 months and 14 years, with an average age of 6.5 years. Half of the patients had an initial Glasgow score of 8/15. This was cerebral oedema in (46.42%) cases. In this study, the rate of endocrine disorders was 85.71%, the exploration of the thyrotropic axis proved normal in all of these patients. Low cortisol levels were observed in 11% of cases, 67.84% of children had hyperprolactinemia. One-third of the patient included in the study had 2-axis involvement, namely cortisol and prolactin. Half, on the other hand, showed only one axis. Conclusion: In the aftermath of head trauma, pituitary disturbances are frequent and should be included in their management.

Immunoglobulin D multiple myeloma (IgD MM) is a rare entity of monoclonal gammopathies. We report the case of a IgD MM, associated with excessive excretion of lambda free light chains (FLL λ) diagnosed and managed at the University Hospital Mohammed VI of Marrakech among an adult hospitalized in the hematology department for bone pain and alteration of the general condition. Indeed, IgD MM is characterized by its clinical severity and poor prognosis. The discretion or absence of a monoclonal peak in the electrophoresis of serum proteins makes detection difficult. The present case demonstrates that IgD MM may be associated with excessive production of CLL and may therefore be erroneously diagnosed as CLL MM. Knowledge of this rare subtype of MM and its epidemiological, clinical and especially biological characteristics is crucial for establishing the correct diagnosis.

Background A colorimetric microassay for the quantitative determination of galactose in the blood was taken and updated. This method helps in diagnosis and follow-up of several inherited metabolic diseases connected to galactose metabolism deficiency such as galactosemia, glycogenosis, glycosylation, tyrosinemia and citrin deficiency. Galactose assay in the blood presents difficulties due to interference with glucose. In this study, we update a method to get around these difficulties. Method This procedure was based on the incubation of whole blood with orcinol in a strongly acidic solution to form a galactose and glucose complexes able to absorb at two different wavelengths. Results The standard curve analysis for the individual solutions of these two sugars showed a wide range of linearity from 0 to 200 mg / l. Under optimal experimental conditions, the stirring time of the orcinol is 3 minutes, the heating time of the reaction is 20 minutes at 56 ° C, and the duration of the incubation in the dark is 40 minutes. The analysis is carried out on fresh blood. The maximum absorbance of galactose and glucose is respectively 569 nm and 421 nm. An adapted diagnosis algorithm was developed based on our results. Conclusion this method could help in screening and identifying patients with hypergalactosemia that need further investigations. It could represent a promising method for neonatal screening in countries with limited resources.

Resume Le deficit en carnitine palmitoyl transferase est un trouble rare de l’oxydation des acides gras mitochondriaux, avec transmission autosomique recessive. Trois formes classiques ont ete decrites : la forme neonatale letale, la forme infantile severe et la forme myopathique. Nous presentons deux cas neonataux admis pour des hypoglycemies non cetotiques, persistantes et des convulsions. Le dosage des acides gras avait confirme le diagnostic de deficit en carnitine palmitoyl transferase. La forme neonatale du deficit en carnitine palmitoyl transferase est letale dans les premiers mois de la vie, d’ou l’interet d’un diagnostic et d’une prise en charge precoce, a completer par un conseil genetique et le depistage dans les familles a risque.

Genetic hyperchylomicronemia is a rare autosomal recessive disorder of lipoprotein metabolism estimated to affect approximately one per million individuals. We report a case with a rare mutation identified. It’s a genetic chylomicronemia in a Moroccan newborn baby, with massive hypertriglyceridemia and clinical signs of acute pancreatitis. She was a newborn female, first-degree of consanguineous parents. She was hospitalized for hypertriglyceridemia, complicated by acute pancreatitis; serum was noted to be milky. The genetic study found a mutation of the Lipoprotein Lipase (LPL) gene: homozygous pathogenic variant c.1019-3C > A. She enjoyed good health, developed well and the triglyceride was maintained at a concentration of

Background: Iodine deficiency early in the life cycle-the "first 1000 days"-can cause hypothyroidism and irreversibly impair neuromotor development. However, the relative vulnerability among women and infants during this critical period is unclear, making it difficult for country-based programs with limited resources to prioritize their iodine interventions.Objective: Our aim was to determine the prevalence of thyroid hypofunction in women and infants living in an area of moderate-to-severe iodine deficiency.Methods: In a cross-sectional survey in Morocco, we measured urinary iodine concentrations (UICs) and concentrations of thyroid-stimulating hormone (TSH) and total or free thyroxine (TT4 or fT4, respectively) in women of reproductive age (n = 156), pregnant women (n = 245), and lactating women (n = 239) and their young infants (n = 239). We calculated daily iodine intakes and measured iodine concentrations in breast milk and household salt. We compared the incidence of hypothyroidism between the 3 groups of women and with the infants.Results: Women of reproductive age, pregnant women, and lactating women had median (IQR) UICs of 41 (29-63), 32 (17-58), and 35 (19-62) μg/L; and estimated iodine intakes were ∼60%, 22%, and 26% of Recommended Nutrient Intakes (RNIs). The infants' median UIC was 73 (28-157) μg/L, which was greater than for all 3 groups of women (P < 0.001), and their dietary intakes were 27% of the RNI. The prevalence of hypothyroidism was not significantly different between the 4 groups, whereas the prevalence of hypothyroxinemia was higher in infants (40%) than in the 3 groups of women (11-14%) (P < 0.001). The median breast-milk iodine concentration was 42 (26-81) μg/L. Only 6% of salt samples were adequately iodized to a concentration of ≥15 ppm; 54% were inadequately iodized and 40% contained no measurable iodine.Conclusions: In an area of moderate-to-severe iodine deficiency, the prevalence of thyroid hypofunction is ∼4-fold higher in young infants compared with the 3 groups of women, suggesting that, in the "first 1000 days," infants are more vulnerable than their mothers and that programs should prioritize iodine prophylaxis for this group.

The xanthinuria is a rare hereditary autosomal recessive disease. It is related to xanthine oxidase deficiency also known as xanthine dehydrogenase, an enzyme involved in the metabolism of purine bases. In this work, we describe the first cases of hereditary xanthinuria in a Moroccan family. We report a case of a 49-year-old woman, with type 2 diabetes, who was referred to the laboratory of clinical biochemistry for the first time for her periodic biological monitoring. In this patient, all measured biochemical parameters were normal except a moderate hyperglycemia and an undetectable uric acid in serum and urine. This prompted us to perform the assay of oxipurine in the urine. Urine samples from the younger brother and sister were also obtained and analyzed. High-performance-liquid-chromatography analysis showed an increase of urinary xanthine and hypoxanthine. The younger brother (43 years old), presented also an undetectable urinary uric acid. The determination of urinary oxipurines revealed an accumulation of xanthine and abnormal hypoxanthine concentration. Faced with these results, the diagnosis of hereditary xanthinuria was confirmed. It is a fortuitous discovery in this Moroccan family. The clinical examination did not find any signs described for this pathology such as myalgia or arthropathies. The presence of kidney stones has not been reported by abdominal ultrasound in our patients. The xanthinuria is a rare hereditary disorder. Xanthine oxidase deficiency is causing the accumulation of oxipurines whose major risk is the formation of xanthine calculi and progression to renal failure. Serious complications of this disease require early prevention by dietary measures in the absence of a specific treatment; so it is very important to detect the disease early, but it remains difficult because of the fact that this pathology is often asymptomatic.

Galactosemia, a life-threatening disorder, is an inherited metabolic disease transmitted in an autosomal recessive manner. It is metabolized in humans and other species predominantly by the sequential activities of three enzymes that constitute the Leloir pathway. A deficiency of any one of the Leloir enzymes in humans, results in a galactosemia. Our study aims to develop a fast and accurate colorimetric technique of qualitative and quantitative determination of galactose in blood. This technique involves incubating the standard galactose and glucose ranges with orcinol in a strongly acidic solution to form a product capable of absorbing light at both wavelengths. This allows the determination of both sugars simultaneously. The standard range of 12.5 to 200 mg/linearity of y = 0.0027x - 0.004, R² = 0.9999 and y = 0.0017x + 0.0129, R² = 0.9963 of glucose and galactose respectively, agitation of orcinol is 3 min, incubation in the dark is 30min. The maximum absorbance of galactose is 569.5 nm while that of glucose is 421 nm. Since galactose in whole blood is unstable over time, all the parameters of the assay have been standardized after 1 year of testing. We have modied a technique colorimetrique that can be applied to the detection of galactosemia. The target analyte is total galactose. We continued to simplify this technique which is fast and economical. The interference between glucose and galactose has been bypassed by a simple calculation which makes it possible to determine the concertration of these two sugars simultaneously. To have good results, certain factors must be maintained, such as time and temperature. Thanks to this method we could diagnose 8 suspected cases of which only one has this disease.

Resume Introduction Le catheter veineux ombilical (CTVO) est largement utilise pour l’abord veineux d’urgence chez le nouveau-ne (N.ne). L’objectif de ce travail est de decrire les principales complications liees au CTVO chez le N.ne au service de reanimation neonatale, hopital Mere-Enfant, CHU Mohamed VI, Marrakech. Patients et methodes Tous les N.nes hospitalises au service de reanimation neonatale du 1er janvier au 30 juin 2010, qui ont necessite la mise en place d’un CTVO, ont ete inclus dans cette etude. L’analyse statistique a ete realisee par le logiciel SPSS 11.0. Resultats Cent soixante-treize N.nes avaient beneficie d’un CTVO. Quatre-vingt-dix-neuf (57,2 %) etaient de sexe masculin. L’âge gestationnel moyen etait de 35,6 (± 2,5) semaine d’amenorrhee, la duree moyenne d’utilisation du CTVO etait de 4,3 (± 1,9) jours. La position initiale etait centrale dans 27,7 % des cas, peripherique dans 17,9 % des cas, au niveau de l’oreillette droite dans 27,2 % des cas et intrahepatique dans 22,5 % des cas. Le repositionnement du catheter etait realise dans 48,6 % des cas. L’incidence d’infection sur catheter etait de 38 episodes sur 1000 journees d’utilisation. Trente-trois episodes infectieux avaient ete rapportes, les principaux germes isoles etaient le Klebsiella pneumoniae dans 11 cas et le staphylocoque metiresistant dans sept cas. Quatre episodes d’hemorragie ombilicale ont ete signales. Conclusion Les principales complications liees au CTVO dans notre serie etaient la malposition initiale et l’infection nosocomiale.

Detection and monitoring of anti-Toxoplasma gondii antibodies are of a great interest among human immunodeficiency virus (HIV)-infected patients, since cerebral toxoplasmosis is a life-threatening opportunistic infection within this vulnerable population. The IgG anti-T. gondii seroprevalence was assessed in 95 asymptomatic HIV-infected adults living in Marrakesh city and its surrounding areas. Our results showed a seroprevalence of 62.1%, which is high compared to most other countries. The mean of CD(4+) T-cells count of involved patients was 381.9cells/μl. Given these results, HIV-infected patients in Marrakesh region could be at high risk to develop toxoplasmosis disease, especially when CD(4+) T-cells count falls below 100cells/μl. Accordingly, there is a serious need of widening antiretroviral therapy and chemoprophylaxis against toxoplasmosis, when indicated, to ovoid toxoplasmosis reactivation among this population.

The nonclassic clinical presentation of celiac disease (CD) becomes increasingly common in physician’s daily practice, which requires an awareness of its many clinical faces with atypical, silent, and latent forms. Besides the common genetic background (HLA DQ2/DQ8) of the disease, other non-HLA genes are now notably reported with a probable association to atypical forms. The availability of high-sensitive and specific serologic tests such as antitissue transglutuminase, antiendomysium, and more recent antideamidated, gliadin peptide antibodies permits to efficiently uncover a large portion of the submerged CD iceberg, including individuals having conditions associated with a high risk of developing CD (type 1 diabetes, autoimmune diseases, Down syndrome, family history of CD, etc.), biologic abnormalities (iron deficiency anemia, abnormal transaminase levels, etc.), and extraintestinal symptoms (short stature, neuropsychiatric disorders, alopecia, dental enamel hypoplasia, recurrent aphtous stomatitis, etc.). Despite the therapeutic alternatives currently in developing, the strict adherence to a GFD remains the only effective and safe therapy for CD.

La cryptosporidiose respiratoire est decrite comme une complication tardive chez les personnes atteintes du sida. Nous rapportons deux cas de cryptosporidiose respiratoire chez les patients infectes par le VIH. Le premier patient etait un homme de 46 ans, souffrant de diarrhee chronique, avec une fievre moderee, une dyspnee progressive et une toux productive. La recherche de bacilles acido-alcoolo-resistants, Pneumocystis jirovecii, Toxoplasma gondii et Cryptococcus sp. dans les crachats etait negative sur plusieurs echantillons. La coloration de Ziehl modifiee a montre des oocystes de Cryptosporidium sp. dans l’expectoration induite. La mort du patient est survenue dans un contexte de troubles hydro-electrolytiques. Le second patient etait hospitalise pour diarrhee chronique compliquee d’une perte de poids, toux seche, une dyspnee stade II et une fievre moderee. Le patient etait VIH-positif et pancytopenique. Cryptosporidium sp. a ete observe dans des echantillons de selles et de l’expectoration induite. Le patient a ete traite quotidiennement par 500 mg d’azithromycine, permettant la disparition des troubles gastro-intestinaux et respiratoires.

Madame EF, âgee de 36 ans, est admise au service de dermatologie pour syndrome d’activation macrophagique (SAM), evoque devant des placards dermo-hypodermiques d’allure inflammatoire, un syndrome tumoral, une pancytopenie, une cholestase biologique, une elevation de la LDH et un aspect d’hemophagocytose a l’etude histologique des biopsies cutanees. La patiente a aussi presente une augmentation exponentielle des triglycerides atteignant 22 g/L. L’evolution a ete marquee par la survenue du deces dans un tableau de defaillance multiviscerale. L’etude de ce cas illustre l’interet de l’hypertriglyceridemie (HTG) dans le diagnostic et le suivi du syndrome d’activation macrophagique mais souligne aussi la difficulte de comprendre sa physiopathologie vue l’intrication de plusieurs elements qui concourent a son aggravation durant l’evolution de ce syndrome.

Resume Objectif Analyser les differents profils du test western-blot (WB) VIH et evaluer leur association aux differents stades cliniques de l’infection. Materiel et methodes Nous avons mene une etude retrospective a partir de 124 cas d’infection a VIH confirmes par WB (HIV BLOT 2.2, MP Diagnostics), au laboratoire d’analyses medicales du CHU Med VI de Marrakech, entre janvier 2007 et fevrier 2008. Pour l’analyse des resultats du test WB, nous avons adopte les criteres d’interpretation de l’OMS. Resultats Une reactivite avec l’ensemble des proteines du test WB VIH-1 ou profil complet (PC : GP160, GP120, P66, P55, P51, GP41, P39, P31, P24, P17) etait note dans 80 % des cas (99/124). Sur l’ensemble des profils etudies, P17 represente la proteine qui manquait le plus frequemment, absente dans 12 % (15/124), contre 6,4 % (8/124) pour P66, P55 et P39 respectivement, 4,8 % (6/124) pour P51 et 3,2 % (4/124) pour P31. En rapportant les resultats de ces profils aux stades cliniques selon la classification CDC 93 (Center for disease control), 79 % (19/24) des cas de stade A, 82 % (18/22) des cas de stade B, et 79,5 % (62/78) des cas de stade C avaient un PC. Parmi ces categories de stades cliniques, nous avons note que le stade C presentait des profils incomplets (PI) variables, avec absence de la bande P17 dans 11 cas sur 16, suivie de P66 (8 cas/16), de P55, P51 et P39 (5 cas/16) respectivement, de P31 (2 cas/16) et de P24 (1 cas/16), alors qu’au niveau des stades A et B, tres peu de proteines manquaient avec notamment l’absence seule de P17 dans 4 cas sur 5 des PI au stade A, et de P39 et P55 dans 3 cas sur 4 chez les patients de stade B. Par ailleurs, nous avons rapporte un seul cas de profil indetermine chez les patients de stade A. Conclusion L’analyse des profils du test WB HIV-1 peut etre occasionnellement consideree comme un outil predictif du stade clinique de l’infection a VIH. Il est cependant necessaire de correler les resultats a une classification combinant les donnees cliniques et le statut immunitaire des sujets malades.

Propos : Cette etude tente de faire une mise au point sur la nature des differents autoanticorps decrits au cours de la sclerodermie systemique, leur interet pour le diagnostic et le pronostic de la maladie, et propose egalement une approche du diagnostic immunologique. La sclerodermie systemique (ScS) est caracterisee par une diversite d’autoanticorps specifiques. Dans plus de 90 % des cas, la ScS s’accompagne d’anticorps antinucleaires. Les Ac anti-centromere et anti-Th/To sont souvent associes a la ScS limitee et au syndrome de CREST, les Ac anti-Scl70, anti-ARN polymerases et anti-U3-RNP/fibrillarine sont des marqueurs de la ScS diffuse avec atteinte multiviscerale. Les Ac anti-PM/Scl et anti-U1-RNP marquent plutot des formes chevauchant respectivement avec la polymyosite et le lupus erythemateux dissemine. Les Ac anti-Ku, anti-B23 et anti-NOR90 constituent une nouvelle generation d’autoAc peu frequents, mais importants par leur correlation avec des formes cliniques specifiques de la ScS. Un autre groupe heterogene d’Ac, non recherches en routine et relevant surtout du domaine de la recherche, comporte les Ac anti-fibrilline 1, anti-cellules endotheliales, anti-annexine V et anti-collagene. Bien que le diagnostic de la sclerodermie soit principalement clinique, ces differents autoAc constituent des outils diagnostiques et pronostiques importants en definissant des formes immunocliniques de la maladie. Le choix des methodes de detection et l’interpretation des resultats se font par etapes : le moyen de depistage de choix est l’immunofluorescence indirecte dont l’aspect guide celui des methodes d’identification specifiques, tels l’immunoprecipitation, l’Elisa ou l’immunoblot.

Background: Lead is a common neurotoxicant and its absorption may be increased in iron deficiency (ID). Thus, iron fortification to prevent ID in populations is a promising lead mitigation strategy. Two common fortificants are ferrous sulfate (FeSO4) and ferric sodium EDTA (NaFeEDTA). EDTA can chelate iron and lead. Objectives: Our study objective was to determine the effects of iron and EDTA, alone and in combination, on blood lead (BPb) concentration, iron status, and cognition. Design: In this 2 × 2 factorial, double-blind placebo-controlled trial, 457 lead-exposed Moroccan children were stratified by school and grade and randomly assigned to consume biscuits (6 d/wk at school) containing 1) ∼8 mg Fe as FeSO4, 2) ∼8 mg Fe as NaFeEDTA that contained ∼41 mg EDTA, 3) ∼41 mg EDTA as sodium EDTA (Na2EDTA), or 4) placebo for 28 wk. The primary outcome was BPb concentration; secondary outcomes were iron status and cognitive outcomes from subtests of the Kaufman Assessment Battery for Children and the Hopkins Verbal Learning Test. These outcomes were measured at baseline and endpoint. All data were analyzed by intention-to-treat. Results: The adjusted geometric mean BPb concentration at baseline was 4.3 μg/dL (95% CI: 4.2, 4.3 μg/dL), and at endpoint these values were 3.3 μg/dL (95% CI: 3.1, 3.5 μg/dL) for FeSO4, 2.9 μg/dL (95% CI: 2.7, 3.0 μg/dL) for NaFeEDTA, 3.3 μg/dL (95% CI: 3.1, 3.5 μg/dL) for EDTA, and 3.7 μg/dL (95% CI: 3.5, 3.9 μg/dL) for placebo. We found an effect of iron (P = 0.009) and EDTA (P = 0.012) for reduced BPb concentrations at endpoint, but no iron × EDTA interaction. Iron fortification improved iron status, but there were no positive effects of iron or EDTA on cognitive test scores. Conclusions: Food fortification with iron and EDTA additively reduces BPb concentrations. Our findings suggest that NaFeEDTA should be the iron fortificant of choice in lead-exposed populations. This trial was registered at clinicaltrials.gov as NCT01573013. ISSN:0002-9165 ISSN:1938-3207

Objective Whether higher serum TSH caused by iodine deficiency adversely affects serum lipids is unknown. Our objective was to determine if correction of iodine deficiency in adults decreases serum...

In iodine deficiency, thyrotropin (TSH) may increase to stimulate thyroidal iodine uptake. In iodine-sufficient populations, higher TSH predicts higher total cholesterol. Whether higher TSH caused by iodine deficiency affects serum lipids is uncertain.Our aim was to determine if iodine repletion decreases serum TSH and improves the lipid profile.In this randomized controlled intervention, iodine-deficient, overweight or obese Moroccan women (n = 163) received 200 μg oral iodine or a placebo daily for 6 mo. Main outcomes were serum TSH and plasma total and LDL cholesterol. Secondary outcomes included thyroid hormones and measures of lipid and glucose metabolism and urinary iodine concentration (UIC). Data were compared by using mixed-model analysis.In the intervention group, median UIC increased from 38 (95% CI: 34, 45) μg/L to 77 (95% CI: 59, 89) μg/L (P0.001). After 6 mo of intervention, TSH was 33% lower in the treatment group than in the placebo group (P = 0.024). The triiodothyronine (T3) to thyroxine (T4) ratio and thyroglobulin decreased with treatment [-15% (P = 0.002) and -32% (P0.001), respectively], whereas T4 concentrations were higher in the treatment group (P0.001). Total cholesterol in subjects with elevated baseline cholesterol (5 mmol/L) was reduced by 11% after the intervention (P = 0.034). At 6 mo, only 21.5% of treated women remained hypercholesterolemic (total cholesterol5 mmol/L) vs. 34.8% of controls (baseline: 44.2% in the intervention and 36.8% in the control group; P = 0.015). The reduction in the prevalence of elevated LDL cholesterol (3 mmol/L) in the intervention group (50.6% to 35.4% compared with 47.4% to 44.9% in the control group) was not significant (P-interaction = 0.23).Our findings suggest that moderate to severe iodine deficiency in overweight women elevates serum TSH and produces a more atherogenic lipid profile and that iodine supplementation in this group reduces the prevalence of hypercholesterolemia. Thus, iodine prophylaxis may reduce cardiovascular disease risk in overweight adults. This trial was registered at clinicaltrials.gov as NCT01985204.

Gemella haemolysans, a Gram positive cocci which are deemed to be the normal inhabitant of the mucous membranes of the oropharynx, has been recognized as a pathogen involved in abscess formation. The aim of this case report is to demonstrate that it is also involved in brain abscess in children. We report, to our knowledge, the first pediatric case of Gemella haemolysans brain abscess in an 11 years old child carrying a complex congenital heart disease (dextrocardia with single right ventricle) which evolved favorably under antibiotic therapy. Because of its similarity with Streptococcus viridans groupe, Gemella haemolysans often remains under-diagnosed in the laboratory. The contribution of microbiologists in its correct identification is very important.

We report the case of a 36-year-old patient admitted for Macrophage Activation Syndrome (MAS), revealed by inflammatory dermo-hypodermal lesions, tumor syndrome, pancytopenia, biological cholestasis, increased lactate dehydrogenase rates and hemophagocytosis in skin biopsies. The patient also exhibited an exponential increase in triglycerides serum levels that reached 22 g/L. The patient died after multiple organ failure. This case illustrates the value of the hypertriglyceridemia in the diagnosis and monitoring of hemophagocytic syndrome but also highlights the difficulty in understanding its pathophysiology especially with several elements that contribute to its aggravation during the evolution of this syndrome.

Introduction Le syndrome de Sheehan (SS) est defini par la necrose de l’hypophyse survenant en post-partum suite a un accouchement hemorragique, realisant un tableau d’insuffisance antehypophysaire dans un delai moyen de 6 a 10 ans. Nous avons mene cette etude pour evaluer la frequence du syndrome de Sheehan dans les suites precoces de l’hemorragie obstetricale grave. Patientes et methodes Durant les 4 ans de l’etude (2009–2012), 182 patientes avec hemorragie obstetricale grave ont ete colligees sur un total de 47 969 accouchements (0,38 %). Apres contact telephonique, 22 malades se sont presentees au service d’endocrinologie pour examen et bilan hormonal. Resultats A l’interrogatoire, aucune malade n’avait d’agalactie et 4 cas d’amenorrhee etaient dus a l’hysterectomie d’hemostase. Les autres symptomes retrouves etaient : l’asthenie (12), l’anorexie (3), baisse du libido (9), troubles psychiques (12), constipation (3) frilosite (3). Cinq de nos patientes avaient eu une grossesse secondaire. A l’examen, 2 malades avaient une atrophie mammaire, 6 des troubles des phaneres, 3 une pâleur cutanee. Sur le plan biologique, 3 patientes ont presente un deficit gonadotrope mais aucun cas de SS n’a ete diagnostique. Discussion Ce travail montre la difficulte a evaluer la prevalence reelle de cette pathologie dans les suites precoces d’une hemorragie grave obstetricale dans notre contexte, mais surtout, la necessite de suivre ces patientes a long terme et d’entreprendre une demarche educative et de sensibilisation vis-a-vis du risque de survenue de cette pathologie.

Introduction La vitamine D joue un role important dans diverses fonctions physiologiques en dehors de son intervention dans le metabolisme phosphocalcique. peu d’etudes se sont interessees a la frequence de sa prevalence chez des femmes jeunes vivant dans zones hautement exposees. Objectif de l’etude Evaluer la frequence de l’hypovitaminose D chez des patientes jeunes vivant a Marrakech. Materiel et methodes Etude transversale realisee chez un total de 96 patientes jeunes âgees de 18 a 45 ans. Un questionnaire a ete utilise pour determiner les facteurs sociodemographiques, les pathologies associees et les facteurs de risque de l’hypovitaminose D. Un bilan phosphocalcique a ete demande avec un dosage de la 25OH Vitamine D. Les valeurs seuils ont ete definis ainsi : deficit 75 nmol/L. Resultats Toutes les patientes etaient en etat d’hypovitaminose D avec une vaeur moyenne de 10,30 ± 8,5 nmol/L ; 78,1 % ont un taux de vitamine D Conclusion Malgre l’ensoleillement de la ville de Marrakech, la prevalence de l’hypovitaminose D chez les femmes jeunes est a 100 %. Ceci pose la problematique de fixer une valeur seuil dans notre contexte. l’hypovitaminose D peut constituer ainsi un probleme de sante publique qu’il faudrait adresser avec une politique de prevention visant a encourager l’exposition au soleil.