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

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

Efficient Wastewater Treatment and Removal of Bisphenol A and Diclofenac in Mesocosm Flow Constructed Wetlands Using Granulated Cork as Emerged Substrate

Constructed wetlands (CWs) are considered as low-cost and energy-efficient wastewater treatment systems. Media selection is one of the essential technical keys for their implementation. The purpose of this work was essentially to evaluate the removal efficiency of organic pollution and nitrogen from municipal wastewater (MWW) using different selected media (gravel/gravel amended with granulated cork) in mesocosm horizontal flow constructed wetlands (HFCWs). The results showed that the highest chemical oxygen demand (COD) and ammonium nitrogen removal of 80.53% and 42%, respectively, were recorded in the units filled with gravel amended with cork. The influence of macrophytes (Phragmites australis and Typha angustifolia) was studied and both species showed steeper efficiencies. The system was operated under different hydraulic retention times (HRTs) i.e., 6 h, 24 h, 30 h, and 48 h. The obtained results revealed that the COD removal efficiency was significantly enhanced by up to 38% counter to the ammonium rates when HRT was increased from 6 h to 48 h. Moreover, the removal efficiency of two endocrine-disrupting compounds (EDCs) namely, bisphenol A (BPA) and diclofenac (DCF) was investigated in two selected HFCWs, at 48 h HRT. The achieved results proved the high capacity of cork for BPA and DCF removal with the removal rates of 90.95% and 89.66%, respectively. The results confirmed the role of these engineered systems, especially for EDC removal, which should be further explored

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

Experimental Analysis and Neural Network Modeling of the Rheological Behavior of Xanthan Gum and Its Derivatives

The main objective of this study was to create a mathematical tool that could be used with experimental data to predict the rheological flow behavior of functionalized xanthan gum according to the types of chemical groups grafted onto its backbone. Different rheological and physicochemical analyses were applied to assess six derivatives synthesized via the etherification of xanthan gum by hydrophobic benzylation with benzyl chloride and carboxymethylation with monochloroacetic acid at three (regent/polymer) ratios R equal to 2.4 and 6. Results from the FTIR study verified that xanthan gum had been modified. The degree of substitution (DS) values varying between 0.2 and 2.9 for carboxymethylxanthan gum derivatives were found to be higher than that of hydrophobically modified benzyl xanthan gum for which the DS ranged from 0.5 to 1. The molecular weights of all the derivatives were found to be less than that of xanthan gum for the two types of derivatives, decreasing further as the degree of substitution (DS) increased. However, the benzyl xanthan gum derivatives presented higher molecular weights varying between 1,373,146 (g/mol) and 1,262,227 (g/mol) than carboxymethylxanthan gum derivatives (1,326,722–1,015,544) (g/mol). A shear-thinning behavior was observed in the derivatives, and the derivatives’ viscosity was found to decrease with increasing DS. The second objective of this research was to create an ANN model to predict one of the rheological properties (the apparent viscosity). The significance of the ANN model (R2 = 0.99998 and MSE = 5.95 × 10−3) was validated by comparing experimental results with the predicted ones. The results showed that the model was an efficient tool for predicting rheological flow behavior

Long-term clinical outcomes of peritoneal dialysis patients: 10-year experience of a single unit from Tunisia

Published data on the outcome of maintenance peritoneal dialysis (PD) since the initiation of PD in Tunisia is poor. The purpose of this study is to report long-term clinical outcomes of PD patients through a 10-year experience at a single unit. This is a retrospective review of the medical records of 182 PD patients who were followed up from January 2006 to June 2016. All patients were followed till death, renal transplant, switch over to hemodialysis (HD) or the end of the study in June 2016. The mean age of the incident patients was 43.93 ± 16.95 years. Nineteen (10.4%) were aged >65 years and 59.3% were male. The average duration of follow-up was 27.75 ± 26.18 months. The mean duration of PD treatment was 27.75 ± 26.18 months. There were 186 episodes of peritonitis that occurred over the total study period (54 episodes during the 1st year). The overall incidence of peritonitis during the 10-year study period was 1 per 27.25 patient months. Mechanical complications were noted in 31.2% of cases. Thirty- two (17.6%) patients had catheter displacement. Only 26 cases of hemoperitoneum (14.3%) were recorded. Death occurred in 23.1% of cases. Twenty-two patients (27.5%) were transplanted; 56 patients (70%) were transferred to HD, one patient had renal recovery and one case had voluntarily interrupted PD. In Kaplan–Meier curves of residual renal function (RRF) loss, there was a significant difference between peritonitis group and peritonitis-free group (P = 0.01). Technique and patient survival were associated with diabetes with a significant difference. The main cause of technique failure was peritonitis (61.4%). Moreover, the main repertoried causes of death were cardiovascular and septic causes. The mortality of diabetic and elderly PD patients was higher than mortality in nondiabetic and nonelderly groups, respectively, in our study. Peritonitis was associated with loss of RRF and technique failure

Rare predicted loss-of-function variants of type I IFN immunity genes are associated with life-threatening COVID-19

BackgroundWe previously reported that impaired type I IFN activity, due to inborn errors of TLR3- and TLR7-dependent type I interferon (IFN) immunity or to autoantibodies against type I IFN, account for 15-20% of cases of life-threatening COVID-19 in unvaccinated patients. Therefore, the determinants of life-threatening COVID-19 remain to be identified in similar to 80% of cases.MethodsWe report here a genome-wide rare variant burden association analysis in 3269 unvaccinated patients with life-threatening COVID-19, and 1373 unvaccinated SARS-CoV-2-infected individuals without pneumonia. Among the 928 patients tested for autoantibodies against type I IFN, a quarter (234) were positive and were excluded.ResultsNo gene reached genome-wide significance. Under a recessive model, the most significant gene with at-risk variants was TLR7, with an OR of 27.68 (95%CI 1.5-528.7, P=1.1x10(-4)) for biochemically loss-of-function (bLOF) variants. We replicated the enrichment in rare predicted LOF (pLOF) variants at 13 influenza susceptibility loci involved in TLR3-dependent type I IFN immunity (OR=3.70[95%CI 1.3-8.2], P=2.1x10(-4)). This enrichment was further strengthened by (1) adding the recently reported TYK2 and TLR7 COVID-19 loci, particularly under a recessive model (OR=19.65[95%CI 2.1-2635.4], P=3.4x10(-3)), and (2) considering as pLOF branchpoint variants with potentially strong impacts on splicing among the 15 loci (OR=4.40[9%CI 2.3-8.4], P=7.7x10(-8)). Finally, the patients with pLOF/bLOF variants at these 15 loci were significantly younger (mean age [SD]=43.3 [20.3] years) than the other patients (56.0 [17.3] years; P=1.68x10(-5)).ConclusionsRare variants of TLR3- and TLR7-dependent type I IFN immunity genes can underlie life-threatening COVID-19, particularly with recessive inheritance, in patients under 60 years old

Correction: Rare predicted loss-of-function variants of type I IFN immunity genes are associated with life-threatening COVID-19

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