BackgroundHepatitis B virus (HBV) is one of the most common human pathogens that cause aggressive hepatitis and advanced liver disease (AdLD), including liver cirrhosis and Hepatocellular Carcinoma. The persistence of active HBV replication and liver damage after the loss of hepatitis B e antigen (HBeAg) has been frequently associated with mutations in the pre-core (pre-C) and core promoter (CP) regions of HBV genome that abolish or reduce HBeAg expression. The purpose of this study was to assess the prevalence of pre-C and CP mutations and their impact on the subsequent course of liver disease in Morocco.Methods/Principal FindingsA cohort of 186 patients with HBeAg-negative chronic HBV infection was studied (81 inactive carriers, 69 with active chronic hepatitis, 36 with AdLD). Pre-C and CP mutations were analyzed by PCR-direct sequencing method. The pre-C stop codon G1896A mutation was the most frequent (83.9%) and was associated with a lower risk of AdLD development (OR, 0.4; 95% CI, 0.15–1.04; p = 0.04). HBV-DNA levels in patients with G1896A were not significantly different from the other patients carrying wild-type strains (p = 0.84). CP mutations C1653T, T1753V, A1762T/G1764A, and C1766T/T1768A were associated with higher HBV-DNA level and increased liver disease severity. Multiple logistic regression analysis showed that older age (≥40 years), male sex, high viral load (>4.3 log10 IU/mL) and CP mutations C1653T, T1753V, A1762T/G1764A, and C1766T/T1768A were independent risk factors for AdLD development. Combination of these mutations was significantly associated with AdLD (OR, 7.52; 95% CI, 4.8–8; p<0.0001).ConclusionsThis study shows for the first time the association of HBV viral load and CP mutations with the severity of liver disease in Moroccan HBV chronic carriers. The examination of CP mutations alone or in combination could be helpful for prediction of the clinical outcome.

One of the most common and serious complications of hepatic hydatid cyst disease is communication between the cyst and the biliary tree. Surgical management of biliary fistula is associated with high morbidity and mortality. We retrospectively reviewed the effectiveness of endoscopic treatment of ruptured hydatid cyst into intrahepatic bile ducts. Diagnosis of intrabiliary rupture of hydatid cyst was mostly suspected by acute cholangitis, jaundice, pain, and/or persistent external biliary fistula after surgery. The diagnosis was confirmed by radiology and endoscopic retrograde cholangiopancreatography (ERCP) findings. We retrospectively reviewed clinical, laboratory, imagery, and ERCP findings for all patients. The therapeutic methods performed were endoscopic sphincterotomy, extraction by balloon or Dormia basket, stenting, or nasobiliary drainage. Sixteen patients with ruptured hepatic hydatid cyst into bile ducts were seen in 9 years. Nine of 16 patients had a surgical history of hepatic hydatid cyst and three patients had a percutanous treatment history. We carried out ERCP with sphincterotomy and extraction of hydatid materials (extraction balloon n = 11; Dormia basket n = 5) or biliary drainage (nasobiliary drainage n = 1; biliary stenting n = 1). The fistula healed in 80 % of patients with a median time of 6 weeks [range, 1-12] after endoscopic treatment. ERCP was an effective method of treatment for hepatic hydatid cyst with biliary fistula.

Objective. In the present study, we aimed to investigate epidemiological, clinical, and etiological characteristics of acute upper gastro-intestinal bleeding. Materials and Methods. This retrospective study was conducted between January 2003 and December 2008. It concerned all cases of acute upper gastroduodenal bleeding benefited from an urgent gastro-intestinal endoscopy in our department in Morocco. Characteristics of patients were evaluated in terms of age, gender, medical history, presenting symptoms, results of rectal and clinical examinations, and endoscopy findings. Results. 1389 cases were registered. As 66% of the patients were male, 34% were female. Mean age was 49. 12% of patients had a history of previous hemorrhage, and 26% had a history of NSAID and aspirin use. Endoscopy was performed in 96%. The gastroduodenal ulcer was the main etiology in 38%, followed by gastritis and duodenitis in 32.5%. Conclusion. AUGIB is still a frequent pathology, threatening patients' life. NSAID and aspirin are still the major risk factors. Their impact due to peptic ulcer remains stable in our country.

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But : Le but de ce travail est d'évaluer l'apport diagnostique de la ponction-biopsie échoguidée dans le diagnostic des masses abdominales. Matériel et méthode : Il s'agit d'une étude rétrospective portant sur 523 biopsies échoguidées colligées dans le service de médecine C sur une période de six années, allant de décembre 2003 à décembre 2009, incluant tous les patients adultes présentant une masse abdominale. Résultats : Deux cent quatre-vingt-trois patients étaient des femmes (54,1 %), et 240 des hommes (45,9 %). Les âges extrêmes étaient respectivement de 17 et 84 ans. Les manifestations cliniques étaient dominées par les douleurs abdominales retrouvées dans 319 cas (61 %), puis la tuméfaction abdominale dans 83 cas (15,8 %). À l'échogra-phie, la masse abdominale siégeait au niveau hépatique chez 370 patients (70,8 %), il s'agissait d'une adénopathie abdominale profonde chez 60 patients (11,5 %), elle siégeait au niveau du pancréas chez 27 patients (5,2 %), du péritoine chez 18 patients (3,4 %), il s'agissait d'un épaississement digestif chez 17 patients (3,2 %). Enfin, la masse était localisée au niveau du pelvis chez sept patientes (1,4 %), des surrénales chez six patients (1,1 %), et de la rate chez trois patients (0,6 %). L'examen histologique retrouvait au niveau hépatique : 279 cas de cancer du foie et 44 cas de tumeur bénigne du foie. Concernant les adénopathies profondes : il s'agissait de 26 cas d'adénite tuberculeuse, 21 cas de LMNH, 12 cas d'adénocarcinome (ADK), six cas d'adénite non spécifique et un cas de sarcoïdose. Au niveau du pancréas : 19 cas d'ADK pancréatique, six cas de pancréatite chronique et un cas de tumeur neuroendocrine. Au niveau du péritoine : dix cas de carcinose péritonéale et trois cas de mésothélium péritonéal. Au niveau surrénalien : quatre cas de métastase surrénale de carcinomes hépatocellulaires (CHC) et un cas de phéochromocytome. Au niveau du pelvis : cinq cas de métastase ovarienne d'ADK digestif. Au niveau digestif et de la rate : cinq cas de LMNH gastrique et trois cas de splénite tuberculeuse. Seules 14,7 % des biopsies (77 cas) n'étaient pas concluantes surtout en raison d'un fragment biopsique trop exigu. Aucune complication majeure n'a été enregistrée.