Medical report on Sidi Abdeljalil Laaroussi, detained in Prison Salé-1

My name is Raabub Mohamed Lamin Mehdi, I am Medical Specialist in Internal Medicine, I perform the function of deputy in Osakidetza (Servicio Vasco de Salud), Collegiate number: 011 304 807, of Spanish nationality , ID number 06287946E 

Through this letter I want to express my concern with the health of the patient Sidi Abdejalil Laaroussi, prisoner number 78608, Saharawi political prisoner, detained in prison Salé1, Rabat in Morocco, that has conveyed to me his situation 

Personal history: 

Apparently healthy, sporty and non-smoking, married with 2 children, had no complaints prior to his arrest. 

After his arrest he was tortured on several occasions, these torture includes violent blows throughout the body, legs and knees causing rupture of ligaments, inhalation of chemicals causing problems to his eyes, blows in the lumbar area, was for more than 4 days naked blindfolded and handcuffed, forced to sleep on his own excrement, suspended from a wooden beam, received electric shocks, his hair was pulled out, repeatedly sexually molested, constantly threatened with the rape of his wife amongst other threats. 

Since then presents a clinical picture characterized by anal pain, rectorragia (bleeding from the rectum), abdominal pain and incontinence to defecate. 

On the other hand describes constante headache, irritability, tachycardia, abdominal and thoracic pain and initially sporadic and lately blood pressure with alarming map values, in recent days considered a hypertensive emergency and must be treated immediately in hospital. 

States that they made several analyzes, and one of the results was sent to a laboratory in France, and several imaging without ever transmitting the diagnosis to Mr. Laaroussi or deliver medical reports or tests results to himself, his family or lawyer. 

States that when he did a colonoscopy, the medical staff asked if he had been raped with an object and told him that he had to be operated to treat the incontinence. 

Mr. Laaroussi states that on one occasion that he was led to make imaging exam, at the clinic along with radiologist was the prison doctor. They made a imaging and from the description I believe that it was a CT scan or an abdominal MRI, they told him he had nothing ......... he threatened that he would present a complaint, and then was told : well, in this exam it is visible (I understand by what you told me the patient) that the left adrenal gland is increased in size. 

With all the data that the patient transmits I can get to the likely conclusion (and likely conclusion because I can't count on exams or reports, nor objective examinations of the patient for several reasons (and one of the main reasons is the impediments of local authorities): 

.- All kinds of exams were made to this patient to reach diagnostic conclusions that were never transmitted to the patient 

.- This patient probably presented rectorragia and currently presents anal sphincter incontinence as a result of torture suffered in the form of rape, confirmed by colonoscopy, since according to the patient the endoscopist asked him (if he was violated with an object) that means that this patient needs to be examined and treated urgently (we are talking about a patient who is 36 years old) 

.- From the symptoms that the patient told me and the possible results of imaging studies (which the patient described to me verbally) it is urgent to discard a secondary hypertension, in a patient so young my first suspicion is that the case of one or at least rule out a pheochromocytoma which I will now describe 

Pheochromocytoma is a tumor of the adrenal medulla, the clinical manifestations are the result of excessive secretion of catecholamines in particular hypertension 

Blood pressure values of Mr. Laaroussi 01/10/2014 to 10/07/2014 

(measurements of blood pressure that I requested and sent by the patient) 

Date 1st measurement 

2nd measurement 

3rd measurement 

4rd measurement 

7H30 13H30 16H30 21H00 

01-10-2014 200/110mmHg 210/100mmHg 220/120mmHg 240/090mmHg 

02-10-2014 190/100mmHg 200/090mmHg 220/110mmHg 220/100mmHg 

03-10-2014 200/100mmHg 220/100mmHg 180/130mmHg 250/090mmHg 

04-10-2014 180/100mmHg 200/090mmHg 220/120mmHg 190/110mmHg 

05-10-2014 200/090mmHg 220/100mmHg 200/110mmHg 230/100mmHg 

06-10-2014 190/100mmHg 210/110mmHg 180/120mmHg 230/090mmHg 

07-10-2014 180/130mmHg 250/090mmHg 220/110mmHg 240/100mmHg 

SYMPTOMS: 

. headache sweating, tachycardia, nervousness and irritability, weight loss, abdominal and chest pain, epistaxis (bleeding from the nose) 

DIAGNOSIS: 

Measuring of the levels of catecholamines (epinephrine and norepinephrine) hormones that control heart rate, blood pressure and metabolism or (degradation products) in the blood and urine (mandelic acid, vanillylmandelic) for 24 hours, and the levels of metanephrine in the urine preferably after a hypertensive attack. 

Computed tomography of the abdomen 

MRI of the abdomen 

Gammagraphy with MIBG 

The treatment consists of removing the tumor with surgery. Before the intervention, it is important to stabilize blood pressure and pulse rate with medication, and it is possible that hospitalization is required with close monitoring of vital signs. 

After surgery, it is necessary to perform a continuous control of all vital signs in an intensive care unit. When the tumor cannot be removed surgically, medication to deal with it is necessary. This usually requires a combination of medications to control the effects of excess hormones. Radiation therapy and chemotherapy are not effective for the cure of this tumor type. 

Taking into account all this information I ask the European authorities and the World Health Organization to act in order to save a life and to see the case of this patient, one of many Saharawi political prisoners in situations of weak and / or dangerous health; health is a fundamental right, patent in the Universal Declaration of Human Rights in its Article 25. The World Health Organization, organizations and institutions must work effectively to ensure it's exercise in its own right. 

Sincerely, 

Dra. Raabub Mohamed Lamin Mehdi 

raabubsaharamedical@gmail.com 

Vitoria, Spain 12th of October 2014