O UR PATIENT, A 40-year-old woman with bipolar disorder, was admitted to our unit complaining of dizziness and diplopia for the last 2 days. The patient had been undergoing stable carbamazepine (CBZ) treatment (600 mg/day) for 10 years. CBZ levels were regularly measured and they were within therapeutic range (7.3 mg/mL, 16 days before admission). Four days before the patient's admission she was prescribed fluconazole (150 mg/day) for a fungal cervical infection. After 2 days of antimycotic treatment, the patient noted double vision, nausea, vomiting and dizziness, which gradually worsened. Neurological examination during her admission revealed a symmetrical, horizontal, high-frequency, gaze-evoked nystagmus. In the examination of the eye smooth pursuit movements, many saccades were noted. All the other neurological examinations, including tests for ataxia or certain eye muscle palsy, were normal. In addition, full blood tests and a brain computed tomography scan were obtained, without any pathological findings. However a toxic, nearly twofold increase of the plasma CBZ levels was noted (plasma CBZ levels were 18 mg/dL, with a therapeutic range 5-10 mg/dL in our laboratory). A day after fluconazole withdrawal, the patient reported that all her symptoms disappeared and the neurological examination was perfectly normal. CBZ plasma levels returned to normal limits (9 mg/mL) 5 days after the antimycotic treatment cessation. All plasma concentrations of CBZ were measured in a morning blood sample, obtained prior to the drug administration.The aforementioned adverse effects were most likely associated with CBZ-fluconazole co-administration. Some first reports of potential stupor 1 or asymptomatic transient increase of CBZ plasma levels 2 after fluconazole and CBZ co-administration have implied a toxicity of this drug combination. The originality of our report is that the symptoms emerged in a patient treated with CBZ as a mood stabilizer for bipolar disorder, in a much lower dosage (600 mg/day) compared with Ulivelli's case report (1200 mg/day). 3The explanation of the above toxic effects could be the metabolism interaction of the two drugs. CBZ is primarily metabolized by the cytochrome P450 3A4 isoenzyme.4,5 CBZ is involved in pharmacokinetic interactions of clinical significance due to its co-administration with other drugs known to inhibit or induce CYP3A4 or other relative isoforms.4 Fluconazole is excreted by the kidney, but has been noted to inhibit CYP3A4 and P2C9 isoenzymes. However, clinically significant drug interactions may occur only in certain patients, 6 depending on several individual characteristics, such as genetics, health, nutrition, age, and concomitant drug administration.Our observation suggests that the interaction between fluconazole and CBZ requires further investigation and clinical attention. The incidence of fungal infections is high in everyday clinical practice. Thus both neurologists and psychiatrists, who use CBZ for its multiple indications, should be aware of toxic effects that may...
Background. Biobanks are highly organized infrastructures that allow the storage of human biological specimens associated with donors’ personal and clinical data. These infrastructures play a key role in the development of translational medical research. In this context, we launched, in November 2015, the first biobank in Morocco (BRO Biobank) in order to promote biomedical research and provide opportunities to include Moroccan and North African ethnic groups in international biomedical studies. Here, we present the setup and the sample characteristics of BRO Biobank. Methods. Patients were recruited at several departments of two major health-care centers in the city of Oujda. Healthy donors were enrolled during blood donation campaigns all over Eastern Morocco. From each participant, personal, clinical, and biomedical data were collected, and several biospecimens were stored. Standard operating procedures have been established in accordance with international guidelines on human biobanks. Results. Between November 2015 and July 2020, 2446 participants were recruited into the BRO Biobank, of whom 2013 were healthy donors, and 433 were patients. For healthy donors, the median age was 35 years with a range between 18 and 65 years and the consanguinity rate was 28.96%. For patients, the median age was 11 years with a range between 1 day and 83 years. Among these patients, 55% had rare diseases (hemoglobinopathies, intellectual disabilities, disorders of sex differentiation, myopathies, etc.), 13% had lung cancer, 4% suffered from hematological neoplasms, 3% were from the kidney transplantation project, and 25% had unknown diagnoses. The BRO Biobank has collected 5092 biospecimens, including blood, white blood cells, plasma, serum, urine, frozen tissue, FFPE tissue, and nucleic acids. A sample quality control has been implemented and suggested that samples of the BRO Biobank are of high quality and therefore suitable for high-throughput nucleic acid analysis. Conclusions. The BRO Biobank is the largest sample collection in Morocco, and it is ready to provide samples to national and international research projects. Therefore, the BRO Biobank is a valuable resource for advancing translational medical research.
Koro syndrome is a psychiatric disorder specific to certain Asian cultures. It is characterized by acute and intense anxiety with fear of a retraction of the penis into the body and resultant death. We report the case of a 43-year-old Moroccan male presenting with persistent anxiety associated with avoidance behaviors and a chronic belief that his genitalia may shrink or disappear and lead to his death. This impacted his professional and family functioning. The diagnosis of culture-bound syndrome was considered although the presenting syndrome was chronic and sporadic. The Moroccan culture, which attributes a great importance to the male sex, would explain this syndrome.
Hyperostosis frontalis interna is an irregular thickening of the frontal bone. Its etiology is unknown. It has been rarely linked with schizophrenia and head injury. Case Presentation. We describe an unusual case of a 44-year-old female with schizophrenia and hyperostosis frontalis interna having a history of head trauma. At the age of 3 years, she had a head injury that could be classified as mild traumatic brain injury. She presents a family history of schizophrenia. She was admitted for resistant schizophrenic disorder. The cranial computed tomography showed bilateral and asymmetrical hyperostosis of the frontal bone that was more pronounced on the right side. This corresponds to the impact of the trauma with frontal atrophy without any metabolic or endocrinal abnormalities. Conclusion. We surmise that the long-term pathological effects of traumatic brain injury, including hyperostosis frontalis interna, are likely to interact with genetic vulnerability and may lead to schizophrenic disorder.
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