La grossesse chez les hémodialysées chroniques

La survenue d'une grossesse en hémodialyse chronique (HDC) est rare, mais depuis la description du premier cas par Confortini en 1971, plusieursobservations ont été rapportées. L'hémodialyse a considérablement  amélioré la fertilité de ces patientes. Nous rapportons l'expérience de  douze grossesses survenues entre 1999 et 2014, chez douze patientes d'âge médian 34 ans (22-44), en hémodialyse (HD) depuis 40 mois  (3-72), l'âge gestationnel moyen de diagnostic est de 16 semaines  d'aménorrhée, la grossesse était compliquée dans 50% des cas par un hydramnios. Le terme moyen est de 35 semaine d'aménorrhée (SA) et l'accouchement a été réalisé dans 90% des grossesses par voie basse. Le poids moyen des nouveau-nés est de 1800g. De telles grossesses sont à haut risque du fait de la fréquence des complications. Elles devraient être contrôlées par les équipes multidisciplinaires, et la consultation prénatal ne devrait pas être négligée. L'objectif de ce travail est de rapporter notre expérience concernant la survenue d'une grossesse chez les patientes dialysées et de la confronter aux données de la littérature

Long-term survivors of childhood cancer report quality of life and health status in parity with a comparison group

Background: There is a need for more knowledge about how survivors of childhood cancer perceive their lives and what influence current health status has on their quality of life. The purpose was to describe this among a group of long-term survivors and among a comparison group. Procedure: Telephone interviews were performed with a cohort of 246 long-term survivors and 296 randomly selected from the general population using the Schedule for the Evaluation of Individual Quality of Life- Direct Weighting (SEIQoL-DW). The participants nominated the areas they considered to be most important in life and rated the current status of each area on a seven-point category scale. An overall individual index score was calculated as a measure of quality of life. Self-reported health status was assessed using the Short Form Health Survey (SF-36). Results: Long-term survivors rated their overall quality of life and self-reported health status almost in parity with the comparison group. In both groups, family life, relations to other people, work and career, interests and leisure activities were the areas most frequently reported to influence quality of life. The survivors only differed from the comparison group on one of eight SF-36 scales reflecting problems with daily activities owing to physical health. Conclusions: Health status was not shown to have a major impact on overall quality of life, indicating that health and quality of life should be evaluated distinctively as different constructs. This should be taken in consideration in clinical care of children with childhood cancer and long-term survivors

Adolescents' and young adults' experiences of childhood cancer: descriptions of daily life 5 years after diagnosis

Background: Survivors of childhood cancer are a growing population in society. These young people have a high risk of developing chronic health problems with a potential strong impact on their lives. How a childhood cancer experience affects survivors in adolescence has only been studied to a limited extent, and an increased understanding of this young group is needed to improve follow-up care. Objective: The aim was to gain a deeper understanding of how childhood cancer affects the lives of survivors by exploring adolescents' and young adults' views of what it is like living with this experience. Methods: Fifty-nine people 11-22 years old were interviewed a median of five years after diagnosis (response rate 66%). Data was collected through telephone interviews and analysed with qualitative content analysis. Results: Three groups of informants were identified according to their descriptions of influence on daily life: ‘Feeling like anyone else’ (the informants who described that the cancer experience had almost no influence on current life) (49%), ‘Feeling almost like others’(those who described some influence) (44%) and ‘Feeling different’ (those describing a great influence on current life) (7%). Conclusions: Most of the adolescents and young adults appear to get along well, although many informants described that life was affected to some extent by having had cancer. Implications for Practice: Necessary follow-up care that can identify those young survivors of childhood cancer having trouble with daily life and offer them support to strengthen their resources in managing difficulties in relation to having had cancer

Antiretroviral activity of 5-azacytidine during treatment of a HTLV-1 positive myelodysplastic syndrome with autoimmune manifestations

Myelodysplastic syndromes (MDS) are often accompanied by autoimmune phenomena. The underlying mechanisms for these associations remain uncertain, although T cell activation seems to be important. Human T-lymphotropic virus (HTLV-1) has been detected in patients with myelodysplastic syndromes, mostly in regions of the world which are endemic for the virus, and where association of HTLV-1 with rheumatological manifestation is not rare. We present here the case of a 58 year old man who presented with cytopenias, leukocytoclastic vasculitis of the skin and glomerulopathy, and was diagnosed as MDS (refractory anemia with excess blasts - RAEB 1). The patient also tested positive for HTLV-1 by PCR. After 8 monthly cycles of 5-azacytidine he achieved a complete hematologic remission. Following treatment, a second PCR for HTLV-1 was carried out and found to be negative. This is the first report in the literature of a HTLV-1-positive MDS with severe autoimmune manifestations, which was treated with the hypomethylating factor 5-azacitidine, achieving cytogenetic remission with concomitant resolution of the autoimmune manifestations, as well as HTLV-1-PCR negativity. HTLV-1-PCR negativity may be due to either immune mediated clearance of the virus, or a potential antiretroviral effect of 5-azacytidine. 5-azacytidine is known for its antiretroviral effects, although there is no proof of its activity against HTLV-1 infection in vivo

Determination of some heavy metals (Fe, Cu, Zn and Pb) in blood by total reflection X-ray fluorescence

The main purpose of this study is the interaction between nutrition (micronutrients heavy metals: Fe, Zn, Cu) and toxic heavy metals such as Pb in blood of children living in Gharb region of Morocco. This region receives all pollution carried by the Sebou river coming mainly from industrial activities. A rapid and simple analytical procedure was used for the determination of Fe, Cu and Zn trace amounts in blood by total-reflection X-ray fluorescence technique. This method is an energy dispersive XRF technique in a special geometry of primary beam, sample and detector. The sample is deposited on a plane polished surface of a suitable reflector material. It is presented as a few drops (25 $\mu$l) from a solution of blood digested in a mixture of HNO$_3$ and H$_2$O$_2$ using a microwaves accelerated reaction system. The accuracy of measurements has been investigated by using certified materials. The concentration of Cu was found to be normal in all samples ($\cong$1 ppm) which ruled out any interaction between this element and the others. On the other hand, amounts of Fe and Zn are very variables, suggesting an interaction between Fe and Zn. However, amounts of Pb in blood are inferior to 50 ppb, suggesting that no interaction exist with this metal and micronutrients

Toxicity and Anxiolytic Property of Nettle in Mice in Light/Dark Test

Background: Anxiety is an unpleasant state of inner turmoil often accompanied by cognitive, somatic, emotional, and behavioral components. There is some evidence in traditional medicine for the effectiveness of Urtica urens in the treatment of anxiety in humans. The present study was designed to study anxiolytic property of aqueous extracts of Urtica urens; an important and commonly used for its medicinal properties belongs to urticaceae family. Methods: The anxiolytic activity was evaluated with the adult mice by hole board test, and the light-dark box test, and motor coordination with the rota rod test. The efficacy of the plant extract (100–400 mg/kg) was compared with the standard anxiolytic drug diazepam (1 mg/kg i.p.). Results: The extract increased the time spent in the brightly-lit chamber of the light/dark box, as well as in the number of times the animal crossed from one compartment to the other. Performance on the rota rod was unaffected. In the hole board test, the extract significantly increased both head-dip counts and head-dip duration. Urtica urens, in contrast to diazepam, had no effect on locomotion. Conclusions: These results provides support for anxiolytic activity of Urtica urens, in line with its medicinal traditional use, and may also suggest a better side-effect profile of Urtica urens relative to diazepam

Morocco

Morocco has well developed irrigation facilities that range from small scale communal systems based on springs, qanats or river diversions to groundwater-based individual initiatives and large scale public schemes. Water demand policies – e.g. water pricing, shift to drip irrigation, 'aquifer contracts' and other forms of participatory management – have shown little potential in curbing overexploitation of resources in many basins. Expansion of irrigated areas and the priority given to productivity have taken their toll on the environment, favored commercial agriculture, and contributed to a net depletion of groundwater estimated at 1 billion m3/year. There is a need to better align agricultural development, water conservation, and environmental objectives. After a short historical perspective, this chapter first reviews a number of trends in the irrigation sector (modernization, development of groundwater resources, wastewater reuse and desalination), before turning to regulatory and institutional issues, including participatory management, economic tools, privatization and an examination of the Plan Maroc Vert. The threats posed by climate change, water scarcity, and environmental degradation are then discussed