Idiopathic Membranous Nephropathy Preceding the Onset of Rheumatoid Arthritis: a Case Report

Introduction: Membranous nephropathy (MN) in the context of rheumatoid arthritis (RA), is often an iatrogenic complication due to the nephrotoxic effects of antirheumatic drugs. Rare cases of non-iatrogenic association between these two diseases were reported in the literature.Case report: A 30-year-old female patient presented in September 2005 with nephrotic syndrome. Renal biopsy showed features consistent with MN. Search for etiology was negative, particularly lupus serology which remained negative throughout the course of her illness. Accordingly, she was diagnosed as a case of idiopathic MN. Initially, she was treated with angiotensin converting enzyme inhibitors and angiotensin receptor blockers which maintained her protein excretion below nephrotic range for two years. Her nephrotic syndrome then relapsed and was treated with steroids and chlorambucil, according to the Ponticelli protocol. A few months later, she presented with early morning joint stiffness, polyarthritis involving the small joints of the hands, and strongly positive rheumatoid factor, fulfilling the diagnostic criteria of rheumatoid arthritis (RA). Her serum creatinine remained normal and a second renal biopsy revealed the same features of MN. Her RA was treated with pulsed methylprednisolone followed by oral steroids and methotrexate resulting in remission of the joints disease and the nephrotic syndrome. Remission was maintained for the last two years up to the time of this report.Conclusion: We hereby report a case of secondary membranous nephropathy that preceded the onset of rheumatoid arthritis by three years.Keywords: Auto-immunity; Membranous nephropathy; Rheumatoid arthriti

Les complications chirurgicales de la transplantation rénale à partir du donneur vivant: expérience du CHU Ibn Sina de Rabat

Introduction: La transplantation rénale (TR) est actuellement considérée comme un traitement de choix de l’insuffisance rénale chronique terminale (IRCT). Ses résultats se sont améliorés au cours des dernières années. Cependant, les complications chirurgicales demeurent graves car elles touchent un rein unique et surviennent sur un terrain fragilisé par l’insuffisance rénale et l’immunosuppression. L’objectif de ce travail est d’évaluer la fréquence des complications chirurgicales lors de l’activité de TR au CHU Ibn Sina de Rabat, et de dégager les facteurs ayant influé l’apparition de ces complications. Méthodes : Étude rétrospective des patients transplantés rénaux à partir de donneurs vivants apparentés (DVA) de Juin 1999 à Décembre 2008 dans notre centre hospitalo-universitaire. Nous avons recensé les caractéristiques propres au receveur, au prélèvement, au donneur ainsi qu’au greffon. Les complications chirurgicales ont été colligées ainsi que leur prise en charge et évolution. Résultats: Soixante sept dossiers ont été analysés avec un suivi moyen de 55 +/- 28 mois. 38 complications chirurgicales ont été recensées : sténose des artères rénales (38,7%), lymphocèle (21%), hématome (12,7%), thrombose vasculaire (7,8%), reflux vésico-urétéral (4,8%), rupture du greffon (3,2%), calcul (1 cas), éventration (1 cas), L’analyse statistique de notre série n’a pas mis en évidence de facteurs de risque significatifs semblant influer sur l’incidence des complications chirurgicales. Conclusion: La morbidité liée aux complications chirurgicales de la TR reste élevée nécessitant un diagnostic et un traitement adéquat afin d’éviter les répercussions sur la survie des patients et des greffons

Association myélome multiple – maladie de Kaposi: à propos d’un cas

L'association Kaposi–myélome multiple est extrêmement rare. Nous rapportons, le cas d'un patient âgé de 76 ans suivi dans notre formation pour un myélome à immunoglobuline A kappa stade III-B selon Durie et Salmon. Ceci a été associé à des lésions cutanées dont la biopsie cutanée était en faveur d’une maladie de Kaposi. La sérologie de l’herpès virus humain de type 8 (HHV8) est revenue positive. Une radiothérapie sur les lésions était refusée par le patient. L'évolution était marquée par une altération de l'état général. Le patient ayant refusé la radiothérapie et toute prise en charge thérapeutique est décédée deux mois plus tard. Nous rapportons, à notre connaissance, le 18ème cas mondial de maladie de Kaposi associée à un Kahler chez un patient HHV8 positif. C'est une association exceptionnelle rendant probable le rôle pathogénique de HHV8 dans le développement du myélome

Breakdown of Conformal Invariance at Strongly Random Critical Points

We consider the breakdown of conformal and scale invariance in random systems with strongly random critical points. Extending previous results on one-dimensional systems, we provide an example of a three-dimensional system which has a strongly random critical point. The average correlation functions of this system demonstrate a breakdown of conformal invariance, while the typical correlation functions demonstrate a breakdown of scale invariance. The breakdown of conformal invariance is due to the vanishing of the correlation functions at the infinite disorder fixed point, causing the critical correlation functions to be controlled by a dangerously irrelevant operator describing the approach to the fixed point. We relate the computation of average correlation functions to a problem of persistence in the RG flow.Comment: 9 page

Disruption of the CYTOCHROME C OXIDASE DEFICIENT1 Gene Leads to Cytochrome c Oxidase Depletion and Reorchestrated Respiratory Metabolism in Arabidopsis

Cytochrome c oxidase is the last respiratory complex of the electron transfer chain in mitochondria and is responsible for transferring electrons to oxygen, the final acceptor, in the classical respiratory pathway. The essentiality of this step makes it that depletion in complex IV leads to lethality, thereby impeding studies on complex IV assembly and respiration plasticity in plants. Here, we characterized Arabidopsis (Arabidopsis thaliana) embryo-lethal mutant lines impaired in the expression of the CYTOCHROME C OXIDASE DEFICIENT1 (COD1) gene, which encodes a mitochondria-localized PentatricoPeptide Repeat protein. Although unable to germinate under usual conditions, cod1 homozygous embryos could be rescued from immature seeds and developed in vitro into slow-growing bush-like plantlets devoid of a root system. cod1 mutants were defective in C-to-U editing events in cytochrome oxidase subunit2 and NADH dehydrogenase subunit4 transcripts, encoding subunits of respiratory complex IV and I, respectively, and consequently lacked cytochrome c oxidase activity. We further show that respiratory oxygen consumption by cod1 plantlets is exclusively associated with alternative oxidase activity and that alternative NADH dehydrogenases are also up-regulated in these plants. The metabolomics pattern of cod1 mutants was also deeply altered, suggesting that alternative metabolic pathways compensated for the probable resulting restriction in NADH oxidation. Being the first complex IV-deficient mutants described in higher plants, cod1 lines should be instrumental to future studies on respiration homeostasis

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries