Identifying Malnutrition in End-stage Renal Disease (ESRD) (P12-037-19).

Objectives: Malnutrition and appetite disturbances, such as anorexia, are commonly reported amongst hemodialysis patients. Nutrition management is a complex issue in ESRD and greater understanding is needed into the associated clinical mediators in ESRD. However, there is currently limited data on anorexia and the pathophysiology framework involved.The aim of this study was to assess the relationship between appetite score and associated clinical biomarkers as a means to identify malnutrition. This work is part of an ongoing international multicenter effort to better define and develop treatment strategies for cachexia in patients with ESRD. Methods: A cross-sectional analysis study included 106 patients from two hemodialysis (HD) units within the United Kingdom (U.K). Appetite score was assessed using the Functional Assessment of Anorexia/Cachexia Therapy (FAACT). Clinical bio-makers included Body Mass Index (BMI), Albumin and C-reactive protein (CRP). Correlations between FAACT and clinical bio-markers were determined using Spearman's rho for non-normally distributed scales. Results: There was no significant relationship between FAACT and albumin levels (r = 0.14; P = 0.16) or BMI (r = 0.28; P = .19). However, there was a moderate and significant negative correlation between FAACT and CRP levels (r = 0.31; P < 0.001) indicating an inverse relationship between appetite (e.g., decreased FAACT score) and CRP levels (e.g., higher inflammation). Conclusions: We found a significant and incremental relationship between inflammation and anorexia which is supported by previous research. The FAACT may be a useful tool in identifying patients at higher risk of malnutrition-inflammation cachexia syndrome which has been associated with higher hospitalization and morality rates. Nutritional status and inflammation are important aspects of clinical practice in ESRD. A more focused approach to anorexia in ESRD is warranted. Funding Sources: This study was funded by the Public Health Agency (Ref: STL/5179/15) and the Northern Ireland Kidney Research Fund. Noble et al., was funded by the National Institute for Health Research and the Health and Social Care Research and Development Division of the Public Health Agency Office Northern Ireland NIHR (CDV/4872/13)

Protein-Energy Wasting and Mortality in Chronic Kidney Disease

Protein-energy wasting (PEW) is common in patients with chronic kidney disease (CKD) and is associated with an increased death risk from cardiovascular diseases. However, while even minor renal dysfunction is an independent predictor of adverse cardiovascular prognosis, PEW becomes clinically manifest at an advanced stage, early before or during the dialytic stage. Mechanisms causing loss of muscle protein and fat are complex and not always associated with anorexia, but are linked to several abnormalities that stimulate protein degradation and/or decrease protein synthesis. In addition, data from experimental CKD indicate that uremia specifically blunts the regenerative potential in skeletal muscle, by acting on muscle stem cells. In this discussion recent findings regarding the mechanisms responsible for malnutrition and the increase in cardiovascular risk in CKD patients are discussed. During the course of CKD, the loss of kidney excretory and metabolic functions proceed together with the activation of pathways of endothelial damage, inflammation, acidosis, alterations in insulin signaling and anorexia which are likely to orchestrate net protein catabolism and the PEW syndrome

Experience of a Design Exercise, Making Use of the Programs: Goal, Bible and Gloss (Developed by Abacus)

A 6 weeks (2 days a week) design exercise, making use of the above programs, was held the last bimester in the Faculty of Architecture in TH Delft. This exercise was an experimental one for the students, as well as for the teachers. As the exercise had an experimental character, it is clear that a lot should be learned from that experience, both from its positive and negative outcomes. The paper will try to evaluate on this point for the benefit of those intending to set up similar projects

Vraagstukken Van Milieurchtelijke Begripsvorming

vi;341hal;25c

La scabiose à Sarcoptes scabiei (généralités et étude de cas)

La scabiose, ou gale humaine à Sarcoptes scabiei hominis, est une affection cutanée d'origine parasitaire cosmopolite qui n'épargne aucune catégorie sociale. Méconnue et contagieuse, cette maladie a su traverser les siècles malgré les progrès réalisés en médecine humaine. En effet, son étiologie n a été que très tardivement établie et mainte fois contestée dans le passé. Elle persiste dans nos sociétés modernes et cause parfois de véritables épidémies, notamment dans les établissements rassemblant des personnes fragilisées. Ce travail détaillera les grandes généralités relatives à cette parasitose et sera conclut par une étude de cas rétrospective se basant sur 4 années de prélèvements dans le service de Parasitologie de l Hôtel-Dieu de Nantes. Cette étude sera mise en comparaison avec les résultats obtenus sur le terrain correspondant à 6 mois de consultations et hospitalisations dans le service de Dermatologie de l Hôtel-Dieu de Nantes. Nous terminerons ce travail en nous interrogeant sur la place du prélèvement effectué par le biologiste en cas de suspicion de gale ainsi qu en soulevant le rôle du pharmacien d officine dans le cadre de cette affection.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF

Phosphate in chronic kidney disease progression

A direct and independent association between serum phosphate (P) levels and mortality has been reported. High circulating P concentrations, still within the normal range, was associated with unfavourable outcomes in normal subjects as well as in chronic kidney disease (CKD) patients. Experimental data support the notion that P overload may hamper survival expectancy, directly inducing vascular, skeletal, and renal ageing. The balance of P results from dietary intake, intestinal absorption, glomerular filtration, tubular resorption, and hormonal asset. However, the accurate estimation of P balance is hampered by several methodological weaknesses, becoming even critical when renal function declines. Increasing evidence in the physiology of P metabolism in humans counteracts with uncertainties on dietary P intake and P balance assessment from general population and CKD subjects