De la malédiction d’être arabe et de quelques moyens, pour un écrivain algérien, d’y échapper

En recouvrant les balises de l’engagement politique, social et poétique qui anime sa vie et son œuvre, et ont fait de lui un écrivain à la fois profondément algérien mais aspirant, dans le même temps, à l’universalité la plus large possible, Anouar Benmalek questionne ce paradoxe du « être arabe, malgré tout » : comment être un écrivain issu du monde arabe, sans renier ce qu’on aime le mieux dans ce monde arabe (sa générosité, son hospitalité, la chaleur des relations humaines, le raffinement des restes d’une grande civilisation où la poésie, par exemple, avait pu passer« pour l’état de béatitude suprême auquel il est permis à un être humain d’accéder de son vivant ») et, en même temps, crier haut et fort la répulsion qu’on éprouve devant la culture de la mort, de la haine des autres, de la femme en particulier, et du ressentiment envers le monde entier qui semble y devenir insidieusement la norme

De la malédiction d’être arabe et de quelques moyens, pour un écrivain algérien, d’y échapper

En recouvrant les balises de l’engagement politique, social et poétique qui anime sa vie et son œuvre, et ont fait de lui un écrivain à la fois profondément algérien mais aspirant, dans le même temps, à l’universalité la plus large possible, Anouar Benmalek questionne ce paradoxe du « être arabe, malgré tout » : comment être un écrivain issu du monde arabe, sans renier ce qu’on aime le mieux dans ce monde arabe (sa générosité, son hospitalité, la chaleur des relations humaines, le raffinement des restes d’une grande civilisation où la poésie, par exemple, avait pu passer« pour l’état de béatitude suprême auquel il est permis à un être humain d’accéder de son vivant ») et, en même temps, crier haut et fort la répulsion qu’on éprouve devant la culture de la mort, de la haine des autres, de la femme en particulier, et du ressentiment envers le monde entier qui semble y devenir insidieusement la norme

What is the lowest change in cardiac output that transthoracic echocardiography can detect?

Abstract Background In critically ill patients, changes in the velocity-time integral (VTI) of the left ventricular outflow tract, measured by transthoracic echocardiography (TTE), are often used to non-invasively assess the response to fluid administration or for performing tests assessing fluid responsiveness. However, the precision of TTE measurements has not yet been investigated in such patients. First, we aimed at assessing how many measurements should be averaged within one TTE examination to reach a sufficient precision for various variables. Second, we aimed at identifying the least significant change (LSC) of these variables between successive TTE examinations. Methods We prospectively included 100 haemodynamically stable patients in whom TTE examination was planned. Three TTE examinations were performed, the first and the third by one operator and the second by another one. We calculated the precision and LSC (1) within one examination depending on the number of averaged measurements and (2) between measurements performed in two successive examinations. Results In patients in sinus rhythm, averaging three measurements within an examination was enough for obtaining an acceptable precision (interquartile range highest value < 10%) for VTI. In patients with atrial fibrillation, averaging five measurements was necessary. The precision of some other common TTE variables depending on the number of measurements is provided. Between two successive examinations performed by the same operator, the LSC was 11 [5–18]% for VTI. If two operators performed the examinations, the LSC for VTI significantly increased to 14 [8–26]%. The LSC between two examinations for other TTE variables is also provided. Conclusions Averaging three measurements within one TTE examination is enough for obtaining precise measurements for VTI in patients in sinus rhythm but not in patients with atrial fibrillation. Between two TTE examinations performed by the same operator, the LSC of VTI is compatible with the assessment of the effects of a 500-mL fluid infusion but is not precise enough for assessing the effects of some tests predicting preload responsiveness

Skin amyloid deposits and nerve fiber loss as markers of neuropathy onset and progression in hereditary transthyretin amyloidosis

Objective: To assess skin biopsy as marker of disease onset and severity in hereditary transthyretin amyloidosis with polyneuropathy (ATTRv-PN), a treatable disease. Methods: In this single center retrospective study, skin Congo red staining and intraepidermal nerve fiber density (IENFD) were evaluated in symptomatic ATTRv-PN patients and asymptomatic TTR gene mutation carriers between 2012 and 2019. Non-ATTRv subjects with small fiber neuropathy suspicion who underwent skin biopsy in the same timespan were used as controls. Results: One-hundred-eighty-three symptomatic ATTRv-PN, 36 asymptomatic carriers, and 537 non-ATTRv patients were included. Skin biopsy demonstrated amyloid depositions in 80% of the 183 symptomatic cases. Skin amyloid deposits were found in 75% of early-stage ATTRv-PN patients, and in 14% of asymptomatic carriers. All 183 symptomatic and 34/36 asymptomatic patients displayed decreased ankle IENFD with a proximal-distal gradient distribution, and reduced IEFND correlated with disease severity and duration. Conclusions: Our study demonstrates skin amyloid deposits are a marker of ATTRv-PN disease onset, and decreased IENFD a marker of disease progression. These results are of major importance for the early identification of ATTRv-PN patients in need of disease-modifying treatments

Cardiac Dysautonomia Predicts Long-Term Survival in Hereditary Transthyretin Amyloidosis After Liver Transplantation

International audienceOBJECTIVES This study sought to compare techniques evaluating cardiac dysautonomia and predicting the risk of death of patients with hereditary transthyretin amyloidosis (mATTR) after liver transplantation (LT). BACKGROUND mATTR is a multisystemic disease involving mainly the heart and the peripheral nervous system. LT is the reference treatment, and pre-operative detection of high-risk patients is critical. Cardiovascular dysautonomia is commonly encountered in ATTR and may affect patient outcome, although it is not known yet which technique should be used in the field to evaluate it. METHODS In a series of 215 consecutive mATTR patients who underwent LT, cardiac dysautonomia was assessed by a dedicated clinical score, time-domain heart rate variability, (123)-meta-iodobenzylguanidine heart/mediastinum ((123)-MIBG H/M) ratio on scintigraphy, and heart rate response to atropine (HRRA). RESULTS Patient median age was 43 years, 62% were male and 69% carried the Val30Met mutation. Cardiac dysautonomia was documented by at least 1 technique for all patients but 6 (97%). In univariate analysis, clinical score, (123)-MIBG H/M ratio and HRRA were associated with mortality but not heart rate variability. The (123)-MIBG H/M ratio and HRRA had greater area under the curve (AUC) of receiver-operating characteristic curves than clinical score and heart rate variability (AUC: 0.787, 0.748, 0.656, and 0.523, respectively). Multivariate score models were then built using the following variables: New York Heart Association functional class, interventricular septum thickness, and either (123)-MIBG H/M ratio (SMIBG) or HRRA (S-atropine). AUC of S-MIBG and S-atropine were greater than AUC of univariate models, although nonsignificantly (AUC: 0.798 and 0.799, respectively). Predictive powers of S-MIBG, S-atropine, and a reference clinical model (AUC: 0.785) were similar. CONCLUSIONS Evaluation of cardiac dysautonomia is a valuable addition for predicting survival of mATTR patients following LT. Among the different techniques that evaluate cardiac dysautonomia, (123)-MIBG scintigraphy and heart rate response to atropine had better prognostic accuracy. Multivariate models did not improve significantly prediction of outcome. (C) 2016 by the American College of Cardiology Foundation