Epidémiologie et devenir de l'insuffisance rénale chronique chez l'enfant : données du registre pédiatrique belge et adaptation à Ho Chi Minh Ville au Viet Nam

L'insuffisance rénale chronique (IRC) chez l'enfant est un problème de santé publique important car la pathologie affecte non seulement le rein mais a aussi des effets délétères sur la croissance et le développement de l'enfant. Il existe peu de données épidémiologiques concernant l'IRC chez l'enfant venant des pays en développement. Dans les pays développés, de nombreuses publications ont porté sur l'insuffisance rénale terminale (IRT), il existe peu de données sur les stades précoces de l'IRC. Notre étude menée sur l'IRC chez les 310 enfants hospitalisés à Ho Chi Minh Ville au Viet Nam de 2001 à 2005 a montré que le nombre annuel de cas enregistrés était de 4.8 par million d'enfants. L'âge médian à l'entrée des patients était de 14 ans. Parmi les 310 enfants, 5% étaient en stade 3, 10% en stade 4 et 85% en stade 5. Les signes cliniques à l'entrée étaient l'anémie (96%), l'hypertension artérielle (74%) et les complications cardio-pulmonaires (39%). Un retard statural était présent chez 72% des enfants et un déficit pondéral était présent chez 63% des patients. Un diagnostic étiologique de l'insuffisance rénale n'a pu être établi chez la moitié des enfants en IRC. Les principales causes de l'IRC connues étaient d'origine glomérulaire (30%), congénitale (16%) et héréditaire (4%). Les patients étaient pris en charge de façon tardive (85% des enfants étaient déjà au stade terminal) et les possibilités de traitement étaient limitées (73% des enfants en IRT n'avaient pas bénéficié d'un traitement de substitution). Durant l'hospitalisation, 15% des patients étaient d��c��dés. La mortalité était plus élevée chez les enfants plus jeunes (1 ? 4 ans), les garçons et les patients dont la néphropathie primitive était acquise. L'acidose métabolique sévère était le facteur prédictif le plus important de mortalité des patients en IRT. Un programme d'intervention est à mener au Viet Nam par le renforcement des méthodes de dépistage et de diagnostic précoce de l'IRC, la formation des professionnels de santé des différents niveaux du système de santé et la mise en place de moyens efficaces et reconnus pour maintenir les patients sous traitement conservateur, le plus longtemps possible, afin de ralentir la progression vers le stade terminal. Les données des 143 patients du registre pédiatrique belge de 2001 à 2005 ont montré que l'incidence de l'IRC estimée à au moins 11.9 par million d'enfants (pme) et de l'IRT (6.2 pme) est comparable aux autres pays européens. La prévalence du traitement de substitution a doublé de 44 pme en 2001 à 82 pme en 2005. L'âge médian au moment de l'enregistrement des enfants ayant une pathologie congénitale, héréditaire et acquise (glomérulopathies) était respectivement de 1 an (interquartile 1? 5), 2 ans (interquartile 1 ? 7) et 10 ans (interquartile 4 ? 12). Au moment de l'enregistrement, 67% des patients étaient en stade 3, 19% en stade 4 et 14% en stade 5. Les causes congénitales représentaient les causes d'IRC les plus fréquentes. Parmi les causes glomérulaires, le syndrome hémolytique et urémique était présent dans la majorité des cas. La progression vers l'IRT des enfants sous traitement conservateur était respectivement de 21 %, de 27 % et de 38 % après 2, 3 et 5 ans de suivi. Elle était plus rapide chez les patients de stade 4 avec 59 % de progression vers l'IRT à 3 ans par rapport à 9 % chez les patients de stade 3 (p < 0.001). La progression vers le stade terminal était 8 fois plus rapide parmi les patients de stade 4, comparant avec le stade 3 (p < 0.001). L'évolution vers le stade terminal était 3 fois plus rapide lorsque la cause est héréditaire que lorsque la cause est congénitale (p = 0.003). Le nombre de transplantations rénales réalisées était de 13 greffes/an dont 34% de transplantations pré-emptives. Le délai d'attente entre la dialyse et la transplantation est en moyenne de 1 an. La survie à 2 ans était de 95% pour les patients transplantés et de 73% pour les patients dialysés. Après ajustement selon l'âge, le sexe et les causes de néphropathie, la mortalité chez les patients dialysés restait 10 fois plus élevée que chez les patients transplantés. La prévention de l'IRC reste un problème majeur pour un pays en développement comme le Viet Nam. En Belgique, la poursuite de l'exploitation des données du registre national existant pourrait permettre de décider des moyens à mettre en oeuvre pour l'amélioration de la prise en charge des enfants atteints d'une maladie rénale chronique.(MED 3) -- UCL, 200

Determinants of early atherosclerosis in obese children and adolescents.

CONTEXT: Obesity in childhood is associated with an increased mortality due to cardiovascular (CV) diseases in adulthood, independent of adult weight. Recent studies in children indicate that the atherosclerosis process starts at an early age and is linked to obesity. OBJECTIVE: The aim of the study was to investigate determinants of increased carotid intima-media thickness (IMT), an early marker of atherosclerosis, in obese children. DESIGN: A total of 104 obese children [age, 12.7 +/- 0.2 yr; body mass index (BMI)-z-score, 2.8 +/- 0.7] underwent an oral glucose tolerance test. Fasting levels of glucose, insulin, C-reactive protein and adhesion molecules (sICAM, sVCAM, sE-selectin), lipid profile, adiponectin, and resistin were determined. IMT was measured by ultrasound. Insulin resistance was estimated by the homeostatic model assessment index. Baseline measurements of blood parameters were obtained from 93 nonobese children (age, 13.0 +/- 0.2 yr; BMI-z-score, -0.2 +/- 0.9), and IMT was measured in 23 other control children with similar characteristics. RESULTS: Univariate analysis showed a significant positive correlation between IMT and relative BMI, the degree of systolic hypertension, fasting insulin levels, homeostatic model assessment-R index, and resistin concentrations, whereas an inverse correlation with adiponectin levels was found. No correlation was obtained between IMT and classical CV risk factors such as positive familial history of type 2 diabetes or precocious CV disease, visceral obesity, or the lipid profile. C-reactive protein and adhesion molecule levels were not associated with IMT in our obese population. When controlled for sex, Tanner stage, and relative BMI, only adiponectin levels remained an independent determinant of IMT. CONCLUSION: Adiponectin more than conventional CV risk factors and inflammation status may be related to early atherosclerosis in obese children

UWB Radio-over-Fiber System Using Direct Modulated VCSEL

The demand for efficient and cost-effective transmission and distribution of RF signal is increasing with the rapid development of wireless communication. This thesis studies the effect of using cost-effective vertical cavity surface emitting laser (VCSEL) to distribute ultra wide band (UWB) RF signal. Properties of multimode and single mode VCSEL are studied and simulated using commercial optical design suite. One of the biggest drawbacks of Orthogonal Frequency Division Multiplexing (OFDM) used by UWB is high peak to average power ratio (PAPR). Signal pre-distortion method is proposed to mitigate nonlinear effect from VCSEL optical system. Software connector is implemented to interconnect the Optical and Wireless design suite. Integrated VCSEL optical link and UWB simulation is carried out for the performance of the radio-on-fiber (RoF) system. The RoF system with optimized single mode VCSEL and proposed pre-distortion method is found to be capable of distributing UWB RF signal

Etiology and outcome of chronic renal failure in hospitalized children in Ho Chi Minh City, Vietnam.

The aim of this study was to investigate the etiology and treatment modalities and to determine mortality risks in hospitalized children with chronic renal failure (CRF) in Ho Chi Minh City, Vietnam. We reviewed the records of 310 children with CRF hospitalized in Ho Chi Minh City from January 2001 to December 2005. The average annual number cases was 4.8 per million child population native to Ho Chi Minh City. Median age was 14 years; 85% of patients were in end-stage renal failure. Associated illnesses were anemia (96%), hypertension (74%), and cardiopulmonary diseases (39%). Causes of included glomerulonephritis (30%) and congenital/hereditary anomalies (20%), but in 50% of children, the etiology was unavailable. Seventy-three percent of cases with end-stage renal failure did not benefit from renal replacement therapy. During hospitalization, 47 patients (15%) died. Mortality risks were higher in young children (1-4 years), in boys, and in patients with acquired pathologies. Severe metabolic acidosis was the main predictive factor of mortality by multivariate regression analysis. Our data shows a poor outcome due to late referral and limited facilities for renal replacement therapy in children with CRF hospitalized in Ho Chi Minh City

Evaluation of skin prick test to screen dust mite sensitization in chronic respiratory diseases in Southern Vietnam.

In the view of the epidemic growth of sensitization to indoor allergens in Southern Vietnam, there is a requirement to screen large population.info:eu-repo/semantics/publishe

Helminth infection induces non-functional sensitization to house dust mites

Background IgE characterizes the humoral response of allergic sensitization but less is known about what modulates its function and why some patients present clinical symptoms for a given IgE level and others do not. An IgE response also occurs during helminth diseases, independently of allergic symptoms. This response could be a model of non-functional IgE. Objective To study the IgE response against environmental allergens induced during natural helminth infection. Methods In 28 non allergic subjects from the periphery of Ho Chi Minh city with (H+, n = 18) and without helminth infection (H-, n = 10), we measured IgE and IgG4 against several components of Dermatophagoïdes pteronyssinus (Dpt) and Ascaris (a marker of immunization against nematodes), and determined the IgE component sensitization profile using microarray ISAC biochips. The functional ability of IgE to induce degranulation of cultured mast cells was evaluated in the presence of Dpt. Results Non allergic H+ subjects exhibited higher levels of IgE against Dpt compared to H- subjects. Dpt IgE were not functional in vitro and did not recognize usual Dpt major allergens. IgE recognized other component allergens that belong to different protein families, and most were glycosylated. Depletion of IgE recognizing carbohydrate cross-reactive determinant (CCD) did not induce a reduction in Dpt IgE. The Dpt IgG4 were not significantly different. Conclusion Helminth infections induced IgE against allergens such as Dpt and molecular components that belong to different sources as well as against CCD (such as β-1,2-xylose and/or α-1,3-fucose substituted N-glycans). Dpt IgE were not able to induce degranulation of mast cells and were not explained by sensitization to usual major allergens or N-glycans.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Difficultés de prise en charge des infections urinaires fébriles chez l'enfant vietnamien

Background: To describe the practical problems related to urinary tract infection (UTI) management in febrile Vietnamese children. Methods: During a prospective 28-month inclusion period, 143 febrile children with significant bacteriuria were treated for UTI in the nephrology department of Nhi Dong 2 children's hospital in Ho Chi Minh City, Vietnam. Patients were treated after blood and urine samples had been taken for culture, according to a local antibiotic protocol, parenterally with ceftriaxone 75. mg/kg/day. Oral treatment with cefixime 8. mg/kg/day was started after 48. h of apyrexia for 2 weeks. According to local protocol, antibiotic therapy was only changed if children did not respond clinically to treatment regardless of antibiogram results. Results: Among these 143 children, 51% were girls and 80% of them had their first UTI before the age of 2 years. The commonest causative agent was Escherichia coli (80% of cases) with a high resistance rate to ampicillin (91%) and cotrimoxazole (74%). Extended-spectrum β-lactamase (. ESBL) production was observed in 52% of Enterobacteriaceae isolates. According to antibiotic susceptibility, the initial treatment with ceftriaxone was found to be inappropriate in 63% of cases. Conclusions: E. coli was responsible for 80% of UTIs in Vietnamese children with a high rate of resistance to first-line antibiotics. ESBL production was found to be extremely high in this study. Based on these data, we propose a new empiric treatment schedule for Vietnamese children suspected of UTI.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

The protective effect of rural life on mite sensitization disappears among urban migrants in the South of Vietnam

info:eu-repo/semantics/publishe