Impact de l'hyper-débit et des maladies cardiaques sur l'incidence d'événements cardiovasculaires aigus chez les dialysés

Introduction : La prévalence de l'insuffisance rénale terminale est en pleine expansion, cela implique un grand nombre de patients en dialyse et donc bénéficiant d'un accès vasculaire. Les maladies cardiovasculaires participent grandement à la morbidité et mortalité des patients en insuffisance rénale terminale et en dialyse. Des changements hémodynamiques importants accompagnent la création d'une fistule artério-veineuse. L'hyper-débit, à savoir un débit fistulaire > 2'000 ml/min, pourrait, pour certains auteurs, représenter un risque supplémentaire pour le développement de complications cardiaques aiguës. Objectif : Investiguer l'influence de l'hyper-débit et des maladies cardiaques existant avant la confection de la fistule artério-veineuse sur la survenue d'événements cardiovasculaires aigus. Méthode : Étude rétrospective sur les dossiers de 23 patients des services de chirurgie vasculaire du CHUV et de l'hôpital de Sion qui ont bénéficié de la création d'une fistule artério-veineuse pour la dialyse entre 2006 et 2013. Les patients ayant un débit fistulaire > 1'800 ml/min ont été inclus dans l'étude. Les informations concernant la maladie rénale et la fistule ont été recueillies dans les dossiers informatiques des patients. Les facteurs de risque cardiovasculaires classiques et les maladies cardiaques présentes avant la confection de la fistule, les mesures échocardiographiques avant et après la confection de l'accès vasculaire ainsi qu'après la dernière révision de celui-ci et enfin, les événements cardiovasculaires aigus survenant entre la confection et la révision de la fistule ont été analysés. Les prévalences et incidences de ces caractéristiques et événements ont pu être extraites pour ce collectif de patients. Résultats : Les facteurs de risque cardiovasculaires et les maladies cardiaques les plus prévalentes dans cette population avant la confection de la fistule artério-veineuse sont l'hypertension artérielle (91.3%), l'hypercholestérolémie (34.8%), le diabète (17.4%), la cardiopathie hypertrophie (34.8%), la cardiopathie ischémique (21.7%). La moyenne globale des mesures de la masse ventriculaire gauche de tous les individus était de 119,4 g/m2 avant la confection de la fistule, 141,9 g/m2 après la confection et à 131.9 g/m2 après la dernière révision de la fistule. La proportion des individus présentant une hypertrophie ventriculaire gauche a varié de 62.5% avant la confection de la fistule à 66.7% après la confection de celle-ci, puis a diminuée à 50% après la dernière révision. Les événements cardiovasculaires aigus ont touché 39% des patients avec une plus grande incidence pour l'insuffisance cardiaque aiguë (21.7%) suivie du syndrome coronarien aigu (13%). Une corrélation entre la présence de maladies cardiaques préexistantes et la survenue d'un événement cardiaque aigu a été observée avec un odds ration de 4.66 (23 observations, intervalle de confiance de 95% compris entre 0.702 et 31.036). Conclusion : Une relation importante entre les maladies cardiovasculaires préexistantes et les événements cardiovasculaires aigus a été mise en évidence dans ce groupe porteur d'une fistule à haut débit. L'hyper-débit pourrait contribuer à une amplification des phénomènes d'agression cardiovasculaire bien connus des états urémiques chroniques et de la dialyse. Un débit élevé, > 2'000 ml/min, devrait donc être considéré comme un facteur de risque cardiovasculaire (FRCV) très important. Des dépistages de maladies cardiovasculaires à l'aide de l'imagerie et de l'examen clinique avant la confection de la fistule devraient être effectués de manière systématique ainsi qu'un suivi régulier du débit fistulaire afin de catégoriser les patients selon le risque d'événements cardiovasculaires. Cette procédure permettrait d'adapter le suivi et la prise en charge des patients

Systemic and immune manifestations in myelodysplasia: a multicenter retrospective study

OBJECTIVE: The presence of systemic and/or immune manifestations in myelodysplasia has been currently reported. The influence of these manifestations on the natural outcome of myelodysplastic syndrome has to be considered. We present a multicenter retrospective study (2002-2009) of patients with myelodysplastic syndrome disclosing systemic and/or immune manifestations. METHODS: Forty-six patients with myelodysplasia presenting with systemic and/or immune manifestations were compared in terms of survival with 189 patients with myelodysplasia lacking these features. RESULTS: The clinical picture in these cases consisted of fever (13%), arthralgia or arthritis (13%), and cutaneous manifestations (67%). Four cases of systemic vasculitis have been reported in our series, and they have a worse prognosis. Immune anomalies were recorded in 29% of the cases, and the presence of cryoglobulins was also associated with a worse prognosis. CONCLUSION: A difference in survival between patients with myelodysplastic syndrome with systemic manifestations and patients lacking these manifestations has been observed in the presence of systemic vasculitis and/or cryoglobulins

The GATA1s isoform is normally down-regulated during terminal haematopoietic differentiation and over-expression leads to failure to repress MYB, CCND2 and SKI during erythroid differentiation of K562 cells

Background: Although GATA1 is one of the most extensively studied haematopoietic transcription factors little is currently known about the physiological functions of its naturally occurring isoforms GATA1s and GATA1FL in humans—particularly whether the isoforms have distinct roles in different lineages and whether they have non-redundant roles in haematopoietic differentiation. As well as being of general interest to understanding of haematopoiesis, GATA1 isoform biology is important for children with Down syndrome associated acute megakaryoblastic leukaemia (DS-AMKL) where GATA1FL mutations are an essential driver for disease pathogenesis. <p/>Methods: Human primary cells and cell lines were analyzed using GATA1 isoform specific PCR. K562 cells expressing GATA1s or GATA1FL transgenes were used to model the effects of the two isoforms on in vitro haematopoietic differentiation. <p/>Results: We found no evidence for lineage specific use of GATA1 isoforms; however GATA1s transcripts, but not GATA1FL transcripts, are down-regulated during in vitro induction of terminal megakaryocytic and erythroid differentiation in the cell line K562. In addition, transgenic K562-GATA1s and K562-GATA1FL cells have distinct gene expression profiles both in steady state and during terminal erythroid differentiation, with GATA1s expression characterised by lack of repression of MYB, CCND2 and SKI. <p/>Conclusions: These findings support the theory that the GATA1s isoform plays a role in the maintenance of proliferative multipotent megakaryocyte-erythroid precursor cells and must be down-regulated prior to terminal differentiation. In addition our data suggest that SKI may be a potential therapeutic target for the treatment of children with DS-AMKL

Fluoride in the Serra Geral Aquifer System: Source Evaluation Using Stable Isotopes and Principal Component Analysis.

Groundwater with anomalous fluoride content and water mixture patterns were studied in the fractured Serra Geral Aquifer System, a basaltic to rhyolitic geological unit, using a principal component analysis interpretation of groundwater chemical data from 309 deep wells distributed in the Rio Grande do Sul State, Southern Brazil. A four-component model that explains 81% of the total variance in the Principal Component Analysis is suggested. Six hydrochemical groups were identified. ??18O and ??2 H were analyzed in 28 Serra Geral Aquifer System samples in order to identify stable isotopes patterns and make comparisons with data from the Guarani Aquifer System and meteoric waters. The results demonstrated a complex water mixture between the Serra Geral Aquifer System and the Guarani Aquifer System, with meteoric recharge and ascending water infiltration through an intensive tectonic fracturing

Qualidade dos cuidados de enfermagem e satisfação do paciente atendido em um hospital de ensino

OBJECTIVES: assess the quality of nursing care, the patients' satisfaction and the correlation between both. METHOD: cross-sectional study, involving 275 patients hospitalized at a teaching hospital in the Central-West of Brazil. The data were collected through the simultaneous application of three instruments. Next, they were included in an electronic database and analyzed in function of the positivity, median value and Spearman's correlation coefficients. RESULTS: among the nursing care assessed, only two were considered safe - hygiene and physical comfort; nutrition and hydration - while the remainder were classified as poor. Nevertheless, the patients were satisfied with the care received in the domains assessed: technical-professional, confidence and educational. This can be justified by the weak to moderate correlation that was observed among these variables. CONCLUSION: Despite the quality deficit, the patients' satisfaction level with the nursing care received was high. These results indicate that the institution needs to center its objectives on a continuing evaluation system of the care quality, aiming to attend to the patients' expectations.OBJETIVOS: evaluar la calidad de los cuidados de enfermería, la satisfacción del paciente y la correlación entre ambos. MÉTODO: estudio trasversal con 275 pacientes internados en un hospital de enseñanza de la región Centro-Oeste de Brasil. Los datos fueron recolectados mediante la aplicación simultánea de tres instrumentos. A seguir, fueron digitalizados en un banco de datos electrónico y analizados en función de la positividad, valor de mediana y coeficientes de correlación de Spearman. RESULTADOS: entre los cuidados de enfermería evaluados, solamente dos fueron considerados seguros - higiene y conforto físico; nutrición e hidratación - y los demás clasificados como pobres. Sin embargo, los pacientes se mostraron satisfechos con los cuidados recibidos en los dominios evaluados: técnico-profesional, confianza y educacional. Eso puede ser justificado por la correlación débil a moderada observada entre esas variables. CONCLUSIÓN: A pesar del déficit de cualidad, fue encontrado alto nivel de satisfacción de los pacientes con los cuidados de enfermería recibidos. Tales resultados indican la necesidad de que la institución centre sus objetivos en un sistema de evaluación permanente de la cualidad del cuidado, visando atender a las expectativas de los pacientes.OBJETIVOS: avaliar a qualidade dos cuidados de enfermagem, a satisfação do paciente e a correlação entre ambos. MÉTODO: estudo transversal, realizado com 275 pacientes internados em um hospital de ensino da Região Centro-Oeste do Brasil. Os dados foram obtidos por meio da aplicação simultânea de três instrumentos. A seguir, foram digitados em banco de dados eletrônico e analisados em função da positividade, valor de mediana e coeficientes de correlação de Spearman. RESULTADOS: dentre os cuidados de enfermagem avaliados, apenas dois foram considerados seguros - higiene e conforto físico; nutrição e hidratação - e os demais foram classificados como pobres. Todavia, os pacientes mostraram-se satisfeitos com os cuidados recebidos nos domínios avaliados: técnico-profissional, confiança e educacional. Isso pode ser justificado pela correlação fraca a moderada observada entre essas variáveis. CONCLUSÃO: apesar do déficit de qualidade, houve alto nível de satisfação dos pacientes com os cuidados de enfermagem recebidos. Tais resultados apontam a necessidade de a instituição centrar seus objetivos num sistema de avaliação permanente da qualidade do cuidado, visando o atendimento das expectativas dos pacientes