COVID-19: Lymphocyte Subpopulations Monitoring in Critically Ill Patients

Background: The alteration of lymphocyte subpopulations can help to predict the severity and the prognosis of severe Coronavirus disease 2019 (COVID-19). Our goal was to describe the kinetics of lymphocyte subsets, and their impact on the severity and mortality in critically ill COVID-19 patients. Methods: We collected demographic data, comorbidities, clinical signs on admission, laboratory findings on admission then a follow-up during hospitalization. Lymphocyte subsets including CD3+ T cells, CD4+ T cells, CD8+ T cells, B cells, and natural killer (NK) cells were counted by flow cytometer. Results: On admission, we observed lymphopenia in 57% of cases, decreased CD3+ T cells in 76% of cases, decreased CD4+ T cells in 81% of cases, decreased CD8+ T cells in 62% of cases, decreased B cells in 52% of cases, and decreased natural killer (NK) cells in 33% of cases. After treatment, decreased CD3+ T cells, decreased CD4+ T cells, decreased CD8+ T cells, and decreased natural killer cells were predictor factors of mortality, in the univariable analysis. Conclusion: CD3+ T cells, CD4+ T cells, CD8+ T cells, and natural killer cells were predictor factors of severity, ICU mortality, and also a useful tool for predicting disease progression.

What Factors Influence the Choice of Anesthesiology in a Moroccan Medical School?

Objective: To determine factors influencing anesthesiology choice among resident doctors at the medical school of Marrakech. Materials and Methods: We have conducted a descriptive cross-sectional study based on an anonymous questionnaire. Results: A total of 406/672 questionnaires were returned, with a female/male sex ratio of 1.07. The duration of the training (OR: 3.3;CI 95%: 1.74 - 6.23;p < 0.001), intellectual challenge (OR: 3.02;CI 95%: 1.69 - 5.37;p < 0.001), doctor-patient relationship (OR: 2.22;CI 95%: 1.02 - 4.84;p: 0.04), and financial aspects (OR: 2.14;CI 95%: 1.09 - 4.21;p: 0.02) were independent factors that influenced the choice of anesthesiology. Conclusion: we recommend the succeeding: 1) Support students in their choice;2) Correct misconceptions about certain specialties;3) Promote clinical clerkship;4) Encourage mentorship;5) Increase the salary of at-risk specialties.

Immunological Manifestations in Paraphenylene Diamine Poisoning

Objective: Our aim is to establish the immunologic profile of PPD-intoxicated persons based on monitoring of the inflammatory reaction. Methods and patients: A prospective study of 21 patients hospitalized in a medical ICU with PPD intoxication during 2010. A follow-up of demographic, clinical, paraclinical, therapeutic and evolutive parameters as well as evaluation of the scores of gravity (SAPS II, APACHE II, OSF) was carried out in all our patients, and an inflammatory check-up (white blood cell, Creactive protein, C3 and C4 fractions of complement and lymphocyte subpopulations CD3, CD4, CD8 and CD19) was realized for all patients. The kinetic of these parameters was compared with clinical and paraclinical evolution. Results: The monitoring of the inflammatory reaction in our patients shows an evolution at three times for this reaction, with the first time of inflammatory stress during the first 3 days after the intoxication characterized by a relative immunodepression, the second time from the third day when the rhabdomyolysis exerts its pro-inflammatory power and the third time (from the sixth day) corresponds to the immunomodulative action of PPD and to its oxidative metabolism. It’s a systemic and specific inflammatory reaction to a cytotoxic cell support, which would explain the secondary worsening of the clinical and paraclinical parameters of our patients (hemodynamic shock, multivisceral failure, etc.). Conclusion: It seems that the immunological aspect may present the answer to several questions that rhabdomyolysis alone could not answer during PPD-poisoning. This study tried to establish a first immunologic profile of PPD-intoxicated persons, and to correlate it with their evolution.

Exceptional Association of a Cerebral Sinus Thrombosis and a Guillain-Barre Syndrome: A New Case Report and Review of the Literature

Background: The association of Guillain-Barre syndrome and cerebral sinus thrombosis is uncommon. Case Presentation: We report a 37-year-old patient hospitalized in medical ICU for respiratory distress following a Guillain-Barre syndrome. He had symptomatic treatment in addition to plasma exchange. In the presence of clonic movements, a brain venography magnetic resonance showed a thrombophlebitis of the left lateral sinus, and hence a low-molecular-weight heparin treatment was begun. Immunological, thrombophilia and serological tests were negative. After a favorable evolution, he was transferred to the neurology department. Conclusion: The combination of a Guillain-Barre syndrome and a cerebral sinus thrombosis would suggest a common process. A rigorous investigation, including the use of imaging, is necessary in front of any unusual clinical sign during a GBS.