Le sujet âgé en hémodialyse chronique: expérience d’un centre hospitalier marocain

De plus en plus de patients âgés sont pris en charge en hémodialyse chronique. L'augmentation de l'incidence de la maladie rénale chronique, du diabète et l'amélioration de la survie cardio-vasculaire expliquent en grande partie ce constat. Les conséquences de la prise en charge de ces patients âgés en en hémodialyse chronique sont multiples. Elles sont dominées par les comorbidités et les troubles d'autonomie. Le but de notre étude est de décrire le profil épidémiologique et clinique des patients âgés traités par HDC dans notre centre. Nous avons réalisé une étude transversale, en Novembre 2011, incluant tous les patients hémodialysés chroniques de l'Hôpital Al Farabi d'Oujda, dans la région de l'Oriental Marocain. Nous avons analysé chez les patients âgés de 65 ans et plus les paramètres démographiques, clinico-biologiques et dialytiques. L'analyse statistique est réalisée par le logiciel SPSS 17,0. Parmi 94 patients hémodialysés chroniques actuellement pris en charge dans notre centre, 31patients sont âgés de 65 ans et plus (32,9%). La néphropathie causale était diabétique dans 6,4% des cas, vasculaire dans 19,35% des cas, et glomérulaire dans 20% des cas. Les comorbidités sont observées chez 65% de ces patients. 29% de patients avaient une comorbidité cardiovasculaire, 55% étaient hypertendus, alors que 6,4% avaient des troubles cognitifs. Les sujets âgés en hémodialyse chronique représentent une population de patients fragiles. Ils nécessitent une surveillance particulière et régulière afin de prévenir certaines complications propres au sujet âgé et améliorer ainsi leur qualité de vie.Key words: Sujet âgé, hémodialyse, insuffisance rénale chronique, comorbidité cardiovasculaire, troubles cognitif

Statut phospho-calcique en hémodialyse chronique dans l’Oriental Marocain: évaluation de l’adhésion aux recommandations K/DOQI et KDIGO

Les troubles phosphocalciques sont fréquents en hémodialyse chronique. Leurs conséquences justifient une prévention et un traitement adaptés aux recommandations des sociétés savantes. L'objectif de notre étude était de déterminer le statut phosphocalcique de nos patients hémodialysés chroniques (HDC) et l'évaluation des taux de conformité des indicateurs aux recommandations K/DOQI et KDIGO. Ainsi, nous avons réalisé une étude transversale incluant les 83 patients HDC du centre d'hémodialyse de l'hôpital Al Farabi d'Oujda. L'âge moyen de nos patients était de 49.8±15.6 ans. Une prédominance masculine a été notée. La conformité des indicateurs du bilan phosphocalcique chez nos patients hémodialysés chroniques par rapport aux recommandations KDIGO était de l'ordre de 21.6%. Le pourcentage des patients ayant des données phosphocalciques conformes aux cibles recommandées par les K/DOQI était Les patients répondants simultanément aux quatres critères recommandés par les K/DOQI n'étaient que 8.4%

Severe Tricuspid Valve Endocarditis Related to Tunneled Catheters in Chronic Hemodialysis Patients: When Should the Catheter be Removed?

Introduction: Hemodialysis (HD) patients are predisposed to infective endocarditis (IE) mainly due to repeated manipulation of the vascular access. However, catheter seeding and IE may also result from a distant infection site.Case series: A diabetic patient who was maintained on regular HD through a permanent catheter in the right internal jugular vein presented with septicemia of urinary origin due to Pseudomonas aeruginosa. He was treated with injectable antibiotics for 15 days. Few days after the end of the treatment period he presented with inflammation of the catheter exit site. Blood cultures revealed Pseudomonas aeruginosa and echocardiography showed a large vegetation on the tricuspid valve, confirming the diagnosis of IE. The patient improved after catheter removal and treatment with ceftazidime, vancomycin and amikacin. Another patient who was maintained on chronic HD through a tunneled catheter in the right internal jugular vein presented with a limited infection in the sub-cutaneous tunnel of the catheter that improved after treatment with injectable antibiotics. Two months later, he presented with severe sepsis without signs of local infection of the catheter. Chest radiography showed right sided infiltrates. Injectable antibiotic therapy was given without improvement. Blood cultures were negative but echocardiography showed a large tricuspid valve vegetation. Antibiotic regimen was modified to include vancomycin, amikacin and ceftazidime and the catheter was removed. Unfortunately, the patient died two days after diagnosing IE.Conclusion: catheter seeding and IE may be a consequence of sepsis originating away from the HD catheter site. Tunneled catheters may need to be pre-emptively removed in such situations to prevent serious IE.Keywords: Hemodialysis; Infective Endocarditis; Tricuspid Valv

Evaluation in vitro de l’effet antifongique de l’extrait aqueux de Daphne gnidium sur Rhynchosporium secalis, agent de la rhynchosporiose de l’orge

Au Maroc, l’orge (Hordeum vulgare) est une culture à double fin, d’une part elle sert pour l’alimentation humaine et d’autre part pour l’alimentation animale. Malheureusement, cette culture est sujette à plusieurs stress dont les stress biotiques. Parmi ces derniers, figure la rhynchosporiose causée par Rhynchosporium secalis, provoquant des pertes de rendement considérables chez la culture de l’orge. Pour développer un moyen de contrôle efficace contre ce pathogène autre que les techniques chimiques et culturelles poursuivies et pour éviter l’intoxication de l’espèce animale qui la consomme à l’état frais, on a eu recours à la lutte biologique. Pour ce faire, on s’est proposé de tester in-vitro l’activité antifongique des extraits de la plante médicinale Daphne gnidium sur la croissance diamétrale de deux souches RS1 et RS2 de Rhynchosporium secalis originaires respectivement de Khémisset et du Gharb. Sept concentrations de D. gnidium ont été testées 20, 40,60, 80, 100, 120 et 140 g/l. Les résultats des tests ont montré que la décoction de D. gnidium a induit une réduction très importante de la croissance mycélienne des deux souches. En effet, le Pourcentage d’inhibition de la croissance diamétrale a atteint 71.58% pour l’isolat RS1 et 68.44% pour l’isolat RS2 à la même concentration de 140g/l

Environmental liability litigation could remedy biodiversity loss

Abstract: Many countries allow lawsuits to hold responsible parties liable for the environmental harm they cause. Such litigation remains largely untested in most biodiversity hotspots and is rarely used in response to leading drivers of biodiversity loss, including illegal wildlife trade. Yet, liability litigation is a potentially ground‐breaking conservation strategy to remedy harm to biodiversity by seeking legal remedies such as species rehabilitation, public apologies, habitat conservation and education, with the goal of making the injured parties ‘whole’. However, precedent cases, expert guidance, and experience to build such conservation lawsuits is nascent in most countries. We propose a simplified framework for developing conservation lawsuits across countries and conservation contexts. We explain liability litigation in terms of three dimensions: (1) defining the harm that occurred, (2) identifying appropriate remedies to that harm, and (3) understanding what remedies the law and courts will allow. We illustrate the framework via a hypothetical lawsuit against an illegal orangutan trader in Indonesia. We highlight that conservationists’ expertise is essential to characterizing harm and identifying remedies, and could more actively contribute to strategic, science‐based litigation. This would identify priority contexts, target defendants responsible for egregious harm, propose novel and meaningful remedies, and build new transdisciplinary collaborations

Circulating microRNAs in sera correlate with soluble biomarkers of immune activation but do not predict mortality in ART treated individuals with HIV-1 infection: A case control study

Introduction: The use of anti-retroviral therapy (ART) has dramatically reduced HIV-1 associated morbidity and mortality. However, HIV-1 infected individuals have increased rates of morbidity and mortality compared to the non-HIV-1 infected population and this appears to be related to end-organ diseases collectively referred to as Serious Non-AIDS Events (SNAEs). Circulating miRNAs are reported as promising biomarkers for a number of human disease conditions including those that constitute SNAEs. Our study sought to investigate the potential of selected miRNAs in predicting mortality in HIV-1 infected ART treated individuals. Materials and Methods: A set of miRNAs was chosen based on published associations with human disease conditions that constitute SNAEs. This case: control study compared 126 cases (individuals who died whilst on therapy), and 247 matched controls (individuals who remained alive). Cases and controls were ART treated participants of two pivotal HIV-1 trials. The relative abundance of each miRNA in serum was measured, by RTqPCR. Associations with mortality (all-cause, cardiovascular and malignancy) were assessed by logistic regression analysis. Correlations between miRNAs and CD4+ T cell count, hs-CRP, IL-6 and D-dimer were also assessed. Results: None of the selected miRNAs was associated with all-cause, cardiovascular or malignancy mortality. The levels of three miRNAs (miRs -21, -122 and -200a) correlated with IL-6 while miR-21 also correlated with D-dimer. Additionally, the abundance of miRs -31, -150 and -223, correlated with baseline CD4+ T cell count while the same three miRNAs plus miR- 145 correlated with nadir CD4+ T cell count. Discussion: No associations with mortality were found with any circulating miRNA studied. These results cast doubt onto the effectiveness of circulating miRNA as early predictors of mortality or the major underlying diseases that contribute to mortality in participants treated for HIV-1 infection

Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study

Ristola M. on työryhmien DAD Study Grp ; Royal Free Hosp Clin Cohort ; INSIGHT Study Grp ; SMART Study Grp ; ESPRIT Study Grp jäsen.Background Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with >= 3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1: 393 chance of developing CKD in the next 5 y in the low risk group (risk score = 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.Peer reviewe

Experimental and Numerical Model of CFRP Retrofitted Concrete Beams with Intermediate Notches Subjected to Drop-Weight Impact

International audienc

Infective endocarditis in chronic hemodialysis: A transition from left heart to right heart

Infective endocarditis (IE) of the left heart is the most frequent type of IE in chronic hemodialysis (CHD) (in 90% of cases) whereas involvement of the right heart is rare. The aim of this study was to determine the clinical, biological, and echocardiographic characteristics, as well as the prognosis of IE in CHD. This is a retrospective study conducted at the Center of Nephrology and Hemodialysis in Oujda, Morocco. Over a period of 56 months, we compiled data on a series of 11 CHD patients with IE. Their mean age was 40.5 ± 14 years, 72% were male and 27.3% had diabetes. All patients had native valve. All patients had bacteremia preceding the episode of IE. The tricuspid valve was the site of IE in 45% of the cases. Cardiac complications were observed in 72% of the patients and mortality was observed in 72% of cases. The period from IE diagnosis to death was 9 ± 6 days. In our study, the tricuspid valve was the most affected valve of IE in CHD