Co-amoxiclav-induced Stevens Johnson Syndrome in a child

Stevens-Johnson Syndrome is an uncommon life threatening disease generally induced by drugs. Antibiotics, mainly sulphonamides, are the most involved drugs in Stevens-Johnson Syndrome in children. Co-amoxiclav is a well tolerated antibiotic. It has never been reported to cause, lonely this syndrome in children. Herein, we report a co-amoxiclav-induced Stevens-Johnson Syndrome occurring in an 18-month-old child. The diagnosis of SJS is often challenging in children and other possible diseases should be ruled out. The etiology of this syndrome is not yet fully understood. It is thought to be mediated by an immunologic mechanism. Management involves early identification, withdrawal of the culprit drug and rapid initiation of supportive therapies.Pan African Medical Journal 2013; 14:3

Effect of fluorine tin oxide substrate on the deposited SnO2: Ni thin films properties for gas sensing

This study explores the deposition of Tin Oxide and Ni-doped SnO2 thin films (NSO) via spray pyrolysis from aqueous solutions. The deposition process was conducted under uniform conditions on two substrates, namely glass and fluorine tin oxide (FTO), with varying Ni percentages. The aim was to evaluate their potential for gas sensing applications. The as-deposited thin films exhibit diverse properties influenced by both Ni content and substrate type. X-Ray Diffraction (XRD) measurements reveal polycrystalline structures characterized by broad SnO2 diffraction lines, with the emergence of a NiO phase, particularly evident at higher Ni content. Notably, thin films deposited on FTO show the appearance of a secondary phase of SnO and enhanced crystallinity. Furthermore, lattice parameters and crystallite size decrease with increasing Ni percentage. The Field Emission Scanning Electron Microscopy (FE-SEM) analysis highlights significant alterations in surface nanostructures based on nickel content and substrate type. Higher nickel concentrations result in the formation of cauliflower-like structures, varying in size and density. This structural divergence significantly impacts the sensitivity of NSO-based NO2 gas sensors. Particularly, thin films with 20 % Ni, especially those deposited on FTO, exhibit optimal configurations for gas sensor applications, display sensitivity of 501 % at 100 ppm for nanocrystalline NSO/FTO compared to 436 % for glass-deposited samples. Our findings highlight the crucial role of Ni content and substrate type in modifying the structural and sensing properties of NSO thin films, for enhanced gas sensing applications

La péritonite chyleuse en dialyse péritonéale

Chylous peritonitis (CP) is a rare complication in patients on peritoneal dialysis. There are many reasons for this. It can occur as a result of a traumatic insertion of the peritoneal dialysis catheter or secondary to infectious or drug causes. The evolution is favorable at the elimination of the causative agent. We report 3 cases of PC occurring in 3 patients on peritoneal dialysis. In 2 patients, CP was secondary to calcium channel blockers and in 1 case associated with lymph node tuberculosis. The cessation of the causative agent allowed a clarification of the effluent dialysate. CP is a mild form of non-infectious peritonitis that is often confused with infectious peritonitis. In this article we discuss the etiologies of CPs, the pathophysiology and the conduct to be held in front of a CP.La péritonite chyleuse (PC) est une complication rare chez les patients en dialyse péritonéale. Les causes sont multiples. Elle peut survenir suite à une insertion traumatique du cathéter de dialyse péritonéale ou secondaire à des causes infectieuses ou médicamenteuses. L’évolution est favorable à l’élimination de l’agent causal. Nous rapportons 3 cas de PC survenant chez 3 patients en dialyse péritonéale. Chez 2 patients, la PC était secondaire à la prise d’inhibiteurs calciques et dans 1 cas associé à une tuberculose ganglionnaire. L’arrêt de l’agent causal a permis un éclaircissement du dialysat effluent. La PC est une forme bénigne de péritonite non infectieuse qui prête souvent à confusion avec les péritonites infectieuses. Dans cet article nous discutons les étiologies des PC, la physiopathologie et la conduite à tenir devant une PC

The inflammatory profile of chronic kidney disease patients

Background: Chronic kidney disease is a worldwide public health issue which is associated with an increased risk of end-stage renal failure and cardiovascular disease. Systemic inflammation exists during chronic renal failure. Recent researches have highlighted the pivotal role of inflammation between renal and cardiovascular disease. The aim of our study is to determine the inflammatory profile of the patient suffering from chronic kidney disease and the influence of hemodialysis on this profile.Methods: We carried out a cross sectional study on 93 patients in the Nephrology Department at Hedi Chaker University Hospital, Sfax, South of Tunisia. Among those patients, 72 patients underwent hemodialysis and 21 patients had chronic kidney disease at stage 3. Clinical data and antecedents were collected. Biological samples were taken after informing the patients and taking their consent. Biological data consisted in lipid profile, albumin rate, hemoglobin rate, uric acid concentration and the usual markers of inflammation noting sedimentation rate, C - reactive protein and orosomucoid.Results: Hemodialysis group of the 72 patients had mean hemodialysis vintage of 54.6 ± 43 months. The inflammatory profile was worse in hemodialysis patients compared to chronic kidney disease patients. Both sedimentation rate, C - reactive protein and orosomucoid were higher in hemodialysis group than in chronic kidney disease group with 71 ± 35.3 mm vs. 42.1 ± 15.5 mm (p < 0.05); 14.6 ± 28.7 mg/l vs. 6.7 ± 8 mg/l (p = 0.02); 1.3 ± 0.7g/l vs. 0.9 ± 0.4 g/l (p = 0.01), respectively.Conclusion: Inflammation increases in dialysis patient. It deserves the nephrologist’s consideration in order to minimize its harmful effects. The monitoring of inflammation markers must be integrated into the nephrologist’s medical practice

La grossesse en hémodialyse chronique: à propos de 25 cas survenus dans le Sud Tunisien

Introduction: la survenue de grossesse au cours de l´hémodialyse chronique est rare. Néanmoins, avec l´évolution des techniques de dialyse, une amélioration de la fertilité est possible. Le but de notre travail est de rapporter notre expérience concernant la survenue d'une grossesse chez les patientes dialysées et de dégager les facteurs impliqués dans sa réussite. Méthodes: notre étude rétrospective a porté sur 25 grossesses spontanées survenues chez 19 patientes traitées par hémodialyse périodique dans différents centres d´hémodialyse du sud tunisien sur une période de 34 ans. Résultats: l´âge maternel de survenue de grossesse était en moyenne égal à 35,6 ans [23-44ans] avec une ancienneté moyenne en hémodialyse de 4,22 ans [1-17 ans]. Sept patientes (37%) avaient une diurèse résiduelle (>500 ml/24h). Le volume horaire hebdomadaire de dialyse était ≥16 heures par semaine dans 7 cas et ≥20 heures dans 4 cas. Le succès de la grossesse (nouveau-né survivant au moins 28 jours) était estimé à 56%. L´âge gestationnel médian était de 34 semaines d´aménorrhée [28-38 SA]. Le poids néonatal moyen est égal à 1970g [1500g-2300g]. L´étude analytique a montré une corrélation significative entre l´augmentation des heures de dialyse par semaine et la réussite de la grossesse (R= 0,59; p= 0,002). Conclusion: on souligne qu´avec une prise en charge adéquate et notamment la majoration du nombre de séances de dialyse, les complications materno-fœtales peuvent être minimisées et la balance risque-bénéfice vire vers donner la chance à une femme dialysée de devenir maman

Pregnancy-Related Complications in Patients With Fibromuscular Dysplasia: A Report From the European/International Fibromuscular Dysplasia Registry

Current literature suggests a higher risk of pregnancy-related complications in patients with renal fibromuscular dysplasia (FMD). The aim of our study was to assess the nature and prevalence of pregnancy-related complications in patients subsequently diagnosed with FMD. A call for participation was sent to centers contributing to the European/International FMD Registry. Patients with at least 1 pregnancy were included. Data on pregnancy were collected through medical files and FMD characteristics through the European/International FMD Registry. Data from 534 pregnancies were obtained in 237 patients. Despite the fact that, in 96% of cases, FMD was not diagnosed before pregnancy, 40% of women (n=93) experienced pregnancy-related complications, mostly gestational hypertension (25%) and preterm birth (20%), while preeclampsia was reported in only 7.5%. Only 1 patient experienced arterial dissection and another patient an aneurysm rupture. When compared with patients without pregnancy-related complications, patients with complicated pregnancies were younger at FMD diagnosis (43 versus 51 years old; P<0.001) and had a lower prevalence of cerebrovascular FMD (30% versus 52%; P=0.003) but underwent more often renal revascularization (63% versus 40%, P<0.001). In conclusion, the prevalence of pregnancy-related complications such as gestational hypertension and preterm birth was high in patients with FMD, probably related to the severity of renal FMD. However, the prevalence of preeclampsia and arterial complications was low/moderate. These findings emphasize the need to screen hypertensive women for FMD to ensure revascularization before pregnancy if indicated and appropriate follow-up during pregnancy, without discouraging patients with FMD from considering pregnancy.Current literature suggests a higher risk of pregnancy-related complications in patients with renal fibromuscular dysplasia (FMD). The aim of our study was to assess the nature and prevalence of pregnancy-related complications in patients subsequently diagnosed with FMD. A call for participation was sent to centers contributing to the European/International FMD Registry. Patients with at least 1 pregnancy were included. Data on pregnancy were collected through medical files and FMD characteristics through the European/International FMD Registry. Data from 534 pregnancies were obtained in 237 patients. Despite the fact that, in 96% of cases, FMD was not diagnosed before pregnancy, 40% of women (n=93) experienced pregnancy-related complications, mostly gestational hypertension (25%) and preterm birth (20%), while preeclampsia was reported in only 7.5%. Only 1 patient experienced arterial dissection and another patient an aneurysm rupture. When compared with patients without pregnancy-related complications, patients with complicated pregnancies were younger at FMD diagnosis (43 versus 51 years old; P<0.001) and had a lower prevalence of cerebrovascular FMD (30% versus 52%; P=0.003) but underwent more often renal revascularization (63% versus 40%, P<0.001). In conclusion, the prevalence of pregnancy-related complications such as gestational hypertension and preterm birth was high in patients with FMD, probably related to the severity of renal FMD. However, the prevalence of preeclampsia and arterial complications was low/moderate. These findings emphasize the need to screen hypertensive women for FMD to ensure revascularization before pregnancy if indicated and appropriate follow-up during pregnancy, without discouraging patients with FMD from considering pregnancy

The European/International Fibromuscular Dysplasia Registry and Initiative (FEIRI)-clinical phenotypes and their predictors based on a cohort of 1000 patients

AIMS: Since December 2015, the European/International Fibromuscular Dysplasia (FMD) Registry enrolled 1022 patients from 22 countries. We present their characteristics according to disease subtype, age and gender, as well as predictors of widespread disease, aneurysms and dissections.METHODS AND RESULTS: All patients diagnosed with FMD (string-of-beads or focal stenosis in at least one vascular bed) based on CTA, MRA and/or catheter-based angiography were eligible.Patients were predominantly women (82%) and Caucasians (88%). Age at diagnosis was 46\ub116 years (12% 6565yo), 86% were hypertensive, 72% had multifocal and 57% multivessel FMD. Compared to patients with multifocal FMD, patients with focal FMD were younger, more often men, had less often multivessel FMD but more revascularizations. Compared to women with FMD, men were younger, had more often focal FMD and arterial dissections. Compared to younger patients with FMD, patients 6565yo had more often multifocal FMD, lower eGFR and more atherosclerotic lesions. Independent predictors of multivessel FMD were age at FMD diagnosis, stroke, multifocal subtype, presence of aneurysm or dissection and family history of FMD. Predictors of aneurysms were multivessel and multifocal FMD. Predictors of dissections were age at FMD diagnosis, male gender, stroke and multivessel FMD.CONCLUSIONS: The European/International FMD Registry allowed large-scale characterization of distinct profiles of patients with FMD and, more importantly, identification of a unique set of independent predictors of widespread disease, aneurysms and dissections, paving the way for targeted screening, management and follow-up of FMD.TRANSLATIONAL PERSPECTIVE: Fibromuscular dysplasia (FMD) is nowadays considered as a systemic arterial disease, warranting brain-to-pelvis vascular imaging in all patients. However, most current evidence is derived from a limited number of expert centres. Furthermore, one size may not fit all. Based on analysis of the first thousand patients enrolled in the European/International FMD registry (46 centres; 22 countries) we characterized distinct patient profiles according to FMD subtype, age and gender and identified predictors of widespread disease, aneurysms and dissections, paving the way for individualized management and follow-up. Further studies will allow refining patient characterization according to ethnicity, genetic profile and imaging biomarkers