Effets de la réduction de la précharge sur les paramètres échographiques de la fonction systolique et diastolique du ventricule gauche de l’enfant en insuffisance rénale terminale : étude comparative avant et après hémodialyse

Purpose

Contrasting data exist about the hemodialysis induced changes of ventricular diastolic and systolic functions in adults. Few data in children with end-stage renal disease (ESRD) are reported. The aim of the present study was to evaluate the effect of a single hemodialysis (HD) session on left ventricular (LV) systolic and diastolic function using conventional pulsed-Doppler echocardiography and pulsed tissue Doppler imaging (TDI) in hemodialysis children.

Methods

Thirty-five children with chronic renal failure (15 males, aged 12.8 ± 3.8 years) on maintenance hemodialysis underwent conventional 2D and Doppler Echo together with measurement of longitudinal mitral annular motion velocities. Echocardiographic parameters were obtained 30 minutes before and 30 minutes after HD. Paired data were compared.

Results

Hemodialysis led to reduction in LV end-diastolic volume (p = 0.001), end-systolic volume (p = 0.05), left atrium area (p < 0.0001), peak early (E wave) transmitral flow velocity (p = 0.005), peak S velocity of pulmonary vein flow (p = 0.002), aortic time velocity integral (p < 0.0001) and aortic ejection time (p < 0.0001). No significant change in Tei Index was observed after HD. Regarding TDI measures, velocities were not affected by preload reduction. Only the early diastolic velocities on the septal side of the mitral annulus decreased significantly (p = 0.001) and the systolic velocities on the lateral side of the mitral annulus increased significantly (p = 0.042) after hemodialysis.

Conclusions

Most of Doppler-derived indices of diastolic function are preload-dependant. TDI velocities and Tei Index were not or minimally affected by preload reduction in hemodialysis children.     

Facteurs de risque cardiovasculaire chez les travailleurs postés d’une centrale de production d’électricité au centre tunisien

The purpose of the study

The aim of the present study was to investigate relationship between shift work and the cardiovascular risk factors.

Methods

A cross-sectional study was included 330 subjects worked in a company of electricity production in the Centre of Tunisia. The collection of data was based on a questionnaire, a clinical exam and biomarkers.

Results

A total of 290 workers was participated in our study (128 shift workers and 162 daytime workers). A raised prevalence but not statistically significant of some factors of cardiovascular risks was found in the shift workers: obesity (25.8 % versus 17.9 %), smoking (44.5 % versus 39.5 %), impaired fasting glucose (11.7 % versus 9.9 %), hypertriglyceridemia (28.1 % versus 25.9 %) and hypercholesterolemia (14.8 % versus 12.4 %). Whereas the prevalence of the alcohol consumption (25.8 % versus 16.0 %) was significantly higher in the shift workers (p = 0.04).

Conclusion

The high prevalence of the cardiovascular risk factors, observed in our shift workers, justify the adoption of measures to protect this category of workers.     

Résultats à court et long terme du remplacement valvulaire mitral par prothèse mécanique à bille et à ailettes (à propos d’une série de 236 patients consécutifs avec un suivi moyen de 11 ans)

Objectives

To study the early and late results of mitral valve replacement (MVR) by Starr-Edwards caged-ball and bileaflet mechanical prosthesis.

Material and methods

We retrospectively analyzed 236 MVR performed in 236 patients: 127 by Starr-Edwards prosthesis (group 1) and 109 by bileaflet prosthesis (group 2).

Results

During the early period (30 days), the mortality rate was higher in group 1 (6.3 % vs 1.8 %; p = 0.0001), while hemorrhagic, thromboembolic and infectious complications were comparable in the two groups. In the late period (> 30 days) and with an average follow-up of 11.5 ± 5.7 years, mortality was higher in group 1 (9.4 % vs 4.6 %; p < 0.0001). The same was true for thromboembolic complications (20.8 % vs 6.4 %; p < 0.0001), hemorrhagic complications (13.4 % vs 7.3 %; p = 0.02), infectious complications (3.1 % vs 0.9 %; p = 0.02) and cardiac complications that were not due to the prosthesis (32.3 % vs 14.7 %; p = 0.02). The hemodynamic profile of the bileaflet prostheses was better than that of the Starr-Edwards prostheses (average functional prosthetic surface area was 2.37 ± 0.44 cm² and average pressure gradient was 5.6 ± 1.1 mmHg vs 2.04 ± 0.52 cm² and 7.6 ± 4.9 mmHg).

Conclusion

Our work confirms the superiority of bileaflet mechanical prostheses, with rates of early and late mortality, thromboembolic and hemorrhagic complications lower than those of the Starr-Edwards prostheses in more than 11 years of follow-up. However, one should not forget that the prevention of infective endocarditis, good observance of oral anticoagulant treatment and early surgery before left ventricular dysfunction occurs remain the best guarantee a good result of the MVR.     

Évaluation du risque hémorragique de différents protocoles d’anticoagulation péri-opératoire lors d’une primo-implantation ou un remplacement d’un stimulateur ou d’un défibrillateur cardiaque : analyse d’une cohorte de patients en centre hospitalier général

Aims

Perioperative management of anticoagulation in patients referred for pacemaker or cardiac defibrillator implantation isn’t consensual. Our objective was to evaluate, in a large cohort, hemorrhagic complications in patients having implantation or replacement of a cardiac pacemaker or defibrillator, and to assess perioperative anticoagulation effect on hemorrhagic risk.

Methods and results

A cohort of 461 consecutive patients having implantation or replacement of a cardiac pacemaker or defibrillator has been analyzed. Thirty patients (6,5%) had oral anticoagulants (OAC) switched to heparin/low-molecular-weight heparin, while 76 (16,5%) had their oral anticoagulation disrupted habitually for 48 hours. A total of six over 30 (20%) and two over 76 (2.6%) patients in the bridge and OAC, respectively experienced a pocket hematoma (bridge vs. OAC, p < 0.05), while ten over 355 (2.8%) had a pocket hematoma in the control group (bridge vs. control p = 0.006). Duration of the hospital stay was longer in the bridge group in comparison with OAC and control groups (9 vs. 7 vs. 6 days, respectively, p = 0.006).

Conclusion

Oral anticoagulation bridging with heparin or low-molecular-weight heparin is associated with a higher risk of pocket hematoma and a longer duration of hospitalization, in comparison with a strategy allowing a temporary disruption of OAC adapted to the thromboembolic risk.     

Lupus hepatitis: a case series of 12 patients

Purpose

Several liver manifestations have been reported in systemic lupus erythematosus (SLE) and are usually non specific. We report on our experience of lupus hepatitis.

Methods

A retrospective monocenter study of 73 patients with SLE. The diagnosis of lupus hepatitis was established after exclusion of other causes of hepatitis and hepatic vein thrombosis.

Results

Liver involvement was noted in 12 patients (16.4%). There were nine female and three male patients; the mean age of these patients was 29 years. In seven patients liver involvement was concurrent with the diagnosis of SLE and it occurred later during an exacerbation of the disease in the five remaining patients. In all patients, liver manifestations were associated with other organ involvement. Clinical manifestations were: hepatomegaly (n = 4), jaundice (n = 4), abdominal pain (n = 3), ascitis (n = 2), portal hypertension (n = 1) and hepatic failure with encephalopathy (n = 1). Elevated liver enzyme was noted in 11 cases and liver cholestasis in eight cases. Presence of anti-ribosomal P antibodies was noted in one case. Liver biopsy was performed in five patients, and revealed chronic active hepatitis in three cases, chronic hepatic granulomas in one case and nonspecific inflammation in one case. The outcome was favorable in 11 patients without relapse, and one patient died of encephalopathy and liver failure.

Conclusion

Liver involvement associated with SLE is not uncommon. It is frequently asymptomatic and limited to liver test abnormalities. The role of anti-ribosomal P autoantibodies remains uncertain.     

Extensive iatrogenic coronary dissection during coronary angioplasty: a series of 19 consecutive patients

Purpose of the study

Extensive coronary dissection is a rare complication of intraluminal angioplasty. We report a retrospective study of 19 patients who consulted in a general hospital without cardiac surgery.

Patients and methods

After consulting our coronarography and angioplasty database, we included the extensive coronary dissections (type D, E and F) in our study. The medical files of the selected patients were analysed.

Results

Between January 2003 and March 2010, 19 coronary angioplasty (total: 2542) were complicated with extensive dissections (incidence 0,75%). For 62,3% of the patients, the dissection was related to the guiding catheter. Eleven patients had type A and B1 lesions. The dissections affected the right coronary artery for 16 patients, the left anterior descending coronary artery for two patients and the left main coronary artery for one patient. After angioplasty, a final TIMI flow 3 was obtained for only 11 patients. In nine cases, we observed a limited extension to the aorta that did not need a chirurgical intervention and had no influence on the prognosis. The complications were common, such as death (n = 1), coronary bypass (n = 2), myocardial infarction (n = 8), cardiogenic shock (n = 2) and circulatory assistance (n = 2).

Conclusion

Extensive coronary dissection is a rare complication of angioplasty. The right coronary is the most frequent vessel concerned and an extension to aorta is usual. The treatment is usually based on sealing the entry with a coronary stent. The complications are common and serious and we did not find any predicting factors to extensive coronary dissections that are unpredictable.     

Valeur prédictive comparée de mortalité hospitalière du peptide natriurétique de type B et de l’albuminémie chez le sujet âgé hospitalisé pour insuffisance cardiaque aiguë sévère

Objective

To address the clinical relevance of serum albumin and B-type natriuretic peptide (BNP) concentration in the prediction of in-hospital death in elderly patients with acute severe heart failure.

Patients and methods

Seventy-four consecutive patients >70 years of age admitted for acute heart failure in NYHA class IV were prospectively included. BNP concentration was measured on admission and serum albumin concentration after clinical stabilization.

Results

Mean age was 86.6 ± 5.7 years. Sixty-five percent of patients had a normal left ventricular ejection fraction. Eighteen patients died during the in-hospital stay. Those patients who died were older, had higher blood urea nitrogen and BNP concentration, had lower systolic blood pressure and serum albumin concentration than patients who survived. Heart rate, rhythm, left ventricular ejection fraction, serum creatinine and hemoglobin did not differ according to outcome. By multivariate analysis, albumin (p = 0.0017), BNP (p = 0.016) and age (p = 0.03) were independent predictors of in-hospital death. Serum troponin I measured on admission in 71 patients was predictive of in-hospital death (p = 0.01), as well as serum total cholesterol measured after stabilization in 66 patients (p = 0.004). However, these two variables no longer predicted outcome in multivariate models, unlike serum albumin and BNP.

Conclusion

Serum albumin and BNP offer independent, additional information for the prediction of in-hospital death in elderly patient with acute severe heart failure regardless of left ventricular ejection fraction.     

Associations des facteurs environnementaux avec le risque de la maladie coronaire à Tlemcen (Algérie)

Purpose

In the purpose of studying the effect of the environmental factors on risk of coronary artery disease, we established a case-control study in Tlemcen.

Method and results

A sample of 568 men and women aged 25 to 64 years, was studied; 170 had had myocardial infarction or angina and 398 controls. Variables associated with CAD were age, sex, tobacco consumption, hypertension, diabetes, obesity, family history of cardiovascular disease, total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol. Adjusted odds-ratio and their 95 % CIs were calculated by logistic regression. Hypertension (OR = 2.48 [1.68; 3.67]), diabetes (OR = 2.86 [1.89; 4.34]), obesity (OR = 1.21 [0.76; 1.92]), family history of cardiovascular disease (OR = 3.49 [1.39; 8.73]), total cholesterol (OR = 0.99 [0.51; 1.92]), triglycerides levels (OR = 1.76 [0.93; 3.35]), HDL-cholesterol (OR = 2.48 [1.69; 3.66]) and LDL-cholesterol (OR = 1.09 [0.59; 2.01]). The variables differing most significantly and independently between cases and controls were identified by stepwise logistic regression analysis (p < 0.05), variables concerned hypertension and diabetes (p < 0.0001), decrease HDL-cholesterol (p = 0.0002) and tobacco consumption (p = 0.005), with stronger associations in cases than in controls.

Conclusion

It is concluded that hypertension and diabetes, decrease HDL-cholesterol in both sexes, an increase in concentration of triglyceride only in women and tobacco consumption in men, were significantly related to coronary artery disease in Tlemcen.     

« Paradoxe des fumeurs » et stratégie de reperfusion à la phase aiguë de l’infarctus du myocarde

Previous studies have shown that smokers with acute myocardial infarction (AMI) treated by thrombolysis have lower mortality rates than nonsmokers, a phenomenon often termed “smoker's paradox”. This “smoker's paradox” has been rarely studied in case of primary angioplasty.

Aim of the study

To evaluate the impact of smoking status on the early mortality of patients admitted with AMI with regard to the strategy of reperfusion (intravenous thrombolysis versus primary angioplasty).

Patients and methods

Study undertaken from the Monsatir registry of ST elevation MI including 688 patients having had either a hospital or a prehospital thrombolysis (n = 397) or a primary angioplasty (n = 291). Among those patients, 482 (70.1%) were active smokers.

Results

In the thrombolysis group, the prevalence of hypertension, diabetes and anterior location of MI was significantly less among smokers. In the group primary angioplasty, only diabetes and hypertension were less frequent. The immediate mortality was significantly less among smokers in case of thrombolysis comparatively to non-smokers (5.3 vs 13%; p = 0.008). By multivariate analysis, cardiogenic shock (p < 0.0001), anterior MI (p = 0.03) and active smoking (p = 0.03) were independent predictive factors of mortality in case of thrombolysis. A trend toward a lower mortality among smokers was observed in the primary angioplasty group (10 vs 17.6%; p = 0.07).

Conclusion

“The smoker's paradox” seems to be observed mainly among patients having had thrombolysis.     

Two-month effects of individualized exercise training with or without caloric restriction on plasma adipocytokine levels in obese female adolescents

Objectives

To examine if, in young obese patients, an individualized training programme in association with a caloric restriction programme which had an effect on whole-body lipid oxidation, was able to induce changes on plasma adipocytokine concentrations.

Materials and methods

Twenty-seven obese female adolescents participated in the study. Whole-body lipid oxidation during exercise was assessed by indirect calorimetry during a graded cycle ergometer test. Body mass (BM), body mass index (BMI), percentage of body fat (%BF), insulin homeostasis model assessment (HOMA-IR) and fasting levels of circulating adipocytokines were assessed prior and after a two-month diet programme, individualized training programme targeted at Lipox_max corresponded to the power at which the highest rate of lipids was oxidized and combined diet/training programme.

Results

The diet/training programme induced both a shift to a higher-power intensity of Lipox_max (+27.8 ± 5.1 W; p < 0.01) and an increase of lipid oxidation at Lipox_max (+96.8 ± 16.2 mg/min; p < 0.01). The enhancement in lipid oxidation was significantly (p < 0.01) correlated with the diet/training-induced improvement in %BF (r = −0.47), HOMA-IR (r = −0.66), leptin (r = −0.41), TNF-α (r = −0.48), IL-6 (r = −0.38), adiponectin (r = 0.43) and resistin (r = 0.51).

Conclusion

This study showed that in obese female adolescents a moderate training protocol targeted at Lipox_max and combined with a diet programme improved their ability to oxidize lipids during exercise, and that this improvement was associated with changes in plasma adipocytokine concentrations.     

ADMA is a correlate of insulin resistance in early-stage diabetes independent of hs-CRP and body adiposity

Objectives

It has been shown that insulin resistance is associated with a state of chronic low-grade inflammation. Furthermore, depletion of nitric oxide (NO) or ineffectiveness of NO-mediated vasodilator mechanisms are associated with arterial stiffness and progression of insulin resistance to type-2 diabetes. In this study, we decided to evaluate the association between asymmetric dimethylarginine ([ADMA], an endogenous NO synthase inhibitor), high-sensitivity C-reactive protein ([hs-CRP]; a marker of chronic inflammation) and insulin resistance in early-stage type-2 diabetes.

Methods

A total of 40 diabetic patients and 40 age-, sex- and body mass index (BMI)-matched healthy adult volunteers were recruited in this case-control study. Diabetic patients were recently diagnosed and did not have a history of any diabetes-related complications. Fasting blood samples were obtained and fasting plasma glucose, cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, creatinine, insulin, ADMA and hs-CRP were measured. Homeostasis model assessment of insulin resistance (HOMA-IR) was also calculated.

Results

ADMA (0.9 ± 0.2 vs 0.7 ± 0.2 μmol/L; p < 0.001) and hs-CRP (3.0 ± 2.1 vs 1.3 ± 1.0 mg/L; p < 0.001) were significantly higher in diabetic participants vs healthy controls. Age- and sex-adjusted ADMA values were significantly (p < 0.05) correlated with hs-CRP (r = 0.279) and HOMA-IR (r = 0.288) in diabetic patients. These associations were not significant in healthy controls. The association between ADMA and HOMA-IR in diabetic patients remained significant (r = 0.255; p < 0.05), after adjustment for BMI, waist circumference, serum lipids, and hs-CRP. In multivariate regression analysis, ADMA and hs-CRP were independently correlated with diabetes.

Conclusion

In early-stage type-2 diabetic patients, ADMA is an independent predictor of insulin resistance. Our results could possibly point to an independent mechanism for contribution of ADMA in development of insulin resistance.     

Renal sarcoidosis: a series of five patients

Introduction

Renal involvement is uncommon in sarcoidosis, occurring in less than 5% of the patients. Diagnostic delay should be minimal to improve the outcome.

Methods

From 1996 to 2009, 78 patients were seen for sarcoidosis in the Department of Internal Medicine of Rouen University hospital.

Results

Five patients (6.4%) had renal involvement. Diagnosis of renal involvement and sarcoidosis were concomitant in two patients while in the three remaining patients, renal manifestations occurred during the course of sarcoidosis. The five patients with renal manifestations exhibited: isolated sarcoid granulomatous interstitial nephritis (n = 2), sarcoid granulomatous interstitial nephritis and nephrocalcinosis (n = 2), renal failure due to hypercalcemia (n = 1).

Conclusion

This series underlines that renal function tests should be performed systematically both during initial evaluation and the follow-up of patients with sarcoidosis.     

Observance médicamenteuse chez un échantillon d’hypertendus dans la région de Sfax (Tunisie)

The aim of the study

Medication noncompliance is one of the daily problems of the physician. Improving the medication adherence allows better management of hypertension. The aim of this work was to determine the level of compliance for patients with hypertension and to identify factors that determine compliance.

Methods

A cross-sectional study was carried out among a sample of hypertensive patients attending general and specialist practitioners in public or private clinics of Sfax. Two hundred and seventy-three participants had accepted to be interviewed. Patients were identified as noncompliants using a questionnaire developed by the Comité de lutte contre l’hypertension artérielle (CFLHTA).

Results

Non-compliance rate was 63.4%. The low level of education was associated with a lower adherence. The monotherapy, the once-daily regimen with fewer number of tablets were associated with a better adherence (p < 10⁻⁶). The welcome and the availability of drugs in the public clinic affect positively the adherence of patients (p < 0.0002). A patient very satisfied with his consultation and the explanation given by the doctor about his illness and its treatment had a better adherence (p < 0.00003).

Conclusion

Our study had demonstrated a low compliance with antihypertensive drug therapy. Tunisian health care system should elaborate a management plan which takes into account our particular predictors of compliance to improve adherence to antihypertensive medication.     

Treatment of diabetic foot ulcers: a comparative study of extracorporeal shockwave therapy and hyperbaric oxygen therapy

Objective

This study compared the effectiveness of extracorporeal shockwave therapy (ESWT) and hyperbaric oxygen therapy (HBOT) in chronic diabetic foot ulcers.

Patients and methods

The ESWT group (39 patients/44 feet) received shockwave therapy twice per week for total six treatments. The HBOT group (38 patients/40 feet) received hyperbaric oxygen therapy daily for total 20 treatments. Evaluations included clinical assessment, blood flow perfusion scan and histopathological examination.

Results

The overall clinical results showed completely healed ulcers in 57% and 25% (P = 0.003); ≥50% improved ulcers in 32% and 15% (P = 0.071); unchanged ulcers in 11% and 60% (P < 0.001) and none worsened for the ESWT and the HBOT group respectively. The blood flow perfusion rates were comparable between the two groups before treatment (P = 0.245), however, significant differences were noted after treatment favoring the ESWT group (P = 0.002). Histopathological examination revealed considerable increases in cell proliferation and decreases in cell apoptosis in the ESWT group as compared to the HBOT group.

Conclusion

ESWT is more effective than HBOT in chronic diabetic foot ulcers. ESWT-treated ulcers showed significant improvement in blood flow perfusion rate and cell activity leading to better healing of the ulcers relative to HBOT in chronic diabetic foot ulcers.     

Small fibre neuropathy in primary Sjögren syndrome

Purpose

About forty percent of the patients with primary Sjögren's syndrome (pSS) experience chronic neuropathic pain with normal electrodiagnostic studies. Two previous studies suggest that chronic neuropathic pain in pSS is due to small fiber neuropathy (SFN). Quantification of epidermal nerve fiber density after skin biopsy has been validated to diagnose small fiber neuropathy.

Methods

Skin biopsy was performed in 14 consecutive pSS patients (satisfying the american-european classification criteria) with chronic neuropathic pain and normal electrodiagnostic studies suggesting SFN.

Résults

Fourteen female pSS patients exhibited chronic neuropathic pain [burning sensation (n = 14), prickling (n = 4), dysesthesia (n = 8)] with paroxystic exacerbations (n = 10) and allodynia (n = 13), for a mean period of 18.4 ± 12.4 months. Neuropathic pain involved mostly hands and feet (n = 13), with a distal (n = 9) and leg (n = 4) predominant distribution. Neurological examination disclosed normal deep tendon responses and absence of motor weakness (n = 14). Small fiber neuropathy was confirmed by skin biopsy in 13 cases. Epidermal nerve fiber density was decreased in distal [(n = 12), mean 3.5 ± 1.7 fibers/mm (N > 6.9)] and proximal site of biopsy [(n = 9), mean 7.04 ± 2.63 fibers/mm (N > 9.3)].

Conclusion

Small fiber neuropathy is commonly responsible of chronic neuropathic pain in pSS. Prevalence, physiopathology and neurological evolution of such neuropathies still remain unknown.     

Hepcidin expression and iron parameters change in Type 2 diabetic patients

Aim

Iron may contribute to the pathogenesis of Type 2 diabetes mellitus (DM). The aim of this study was to determine iron regulator hepcidin and iron metabolic parameters in Type 2 DM patients, the relationships among them were evaluated in this specific sub-groups.

Materials and methods

The study included sixty-four people: 34 cases of diabetes and 30 age-matched controls. Serum hepcidin, IL-6, hsCRP, ferritin, sTfR, EPO as well as other clinical parameters were detected, and the associations between hepcidin levels and iron/inflammatory parameters were analyzed in diabetes and the controls.

Results

Serum ferritin and hepcidin levels in diabetic patients were significant higher than the controls (p < 0.001 respectively). A positive correlation between hepcidin and ferritin, as well as between ferritin and IL-6 levels was existed in diabetes and the control groups (p < 0.001 respectively).

Conclusion

All of these data demonstrated that the higher hepcidin levels in diabetic patients may be due to those higher ferritin and IL-6 levels, the elevated hepcidin might have adaptive value through down-regulated iron absorb and play an important role in pathogenesis of Type 2 DM.     

Influence des leucocytes sur la réserve coronaire, la fonction systolique ventriculaire gauche, et les complications hospitalières, dans l’infarctus antérieur aigu traité par angioplastie primaire

Objective

To assess the relationship between leukocyte count, non invasive coronary flow reserve (CFR), left ventricular systolic function, and in-hospital adverse events in acute anterior myocardial infarction (AMI) treated by primary angioplasty.

Methods

Leukocyte count at admission and within 24 h after angioplasty, and differential count at admission were obtained in 72 consecutive patients with a first AMI (mean age 56 ± 12 years) successfully treated by primary angioplasty. Transthoracic Doppler echocardiography was performed within 24 h after angioplasty and 3 months later to assess the CFR (using intravenous adenosine), in the left anterior descending artery (LAD), left ventricular ejection fraction (LVEF) and the wall motion score index using the nine segments assigned to the LAD territory (WMSi-lad). In hospital events were defined as death, heart failure (Killip ≥ 2) and reinfarction.

Results

Leukocyte count was higher before and after angioplasty in patients with impaired acute CFR (< 1.7), when compared to patients without such impairment (P ≤ 0.01), and a significant correlation was found between CFR and leukocyte, neutrophil and monocyte count (P < 0.05). Leukocyte (before and after angioplasty), and neutrophil count, were lower in patients with recovery of global and regional LV function (P < 0.05). A significant correlation was found between leukocyte count before and after angioplasty, and, initial and follow-up LVEF, and WMSi-lad (all, P ≤ 0.01). Leukocyte (before and after angioplasty) and monocyte count were higher in patients with in-hospital events (n = 14), by comparison to patients without events (all, P < 0.01). In multivariate analysis, leukocyte count after angioplasty was an independent predictor of CFR, and in-hospital events, and neutrophil count of WMSi-lad at follow-up (all, P < 0.05).

Conclusion

In the first AMI treated successfully by primary angioplasty, leukocyte count is inversely correlated to CFR, and global and regional LV systolic function at follow-up. These links are higher after than before reperfusion. And, leukocyte count after angioplasty is an independent predictor of in-hospital adverse events.     

Hyperuricemia in sickle cell disease in France

Purpose

Hyperuricemia has been reported to be a common feature of sickle cell disease occurring between 32 to 41% of the patients, in studies conducted during the 1970's. Since then, this notion has been rarely challenged. The objective of this study was to assess the prevalence of hyperuricemia and gout in adult patients with sickle cell disease in France.

Methods

Between May 2007 and March 2009, serum and urinary urate concentration, creatininemia and hemogram were prospectively assessed in all consecutive sickle cell patients, followed in our sickle cell disease centre. All subjects were in a clinically steady state. Clinical acute gout history was also recorded.

Results

Sixty-five patients (mean age 31 ± 10.3 years) were investigated. Mean uric acid serum level was 281.6 ± 74 μmol/L. Hyperuricemia was evidenced in six patients only (9.2%) (95% IC: 3.5-19.0). None of the patient had a medical history of acute gout. Patients in the higher serum uric acid tertile concentration had higher serum creatinine level (62.3 ± 17.1 μmol/L vs 51.5 ± 12.6 μmol/L, P < 0.01), lower fractional excretion of urate (4.5% vs 6.8%, P < 0.03) and higher reticulocyte count (median 219 500/mm³ vs 144 000/mm³, P = 0.08) compared to the other patients.

Conclusion

Hyperuricemia and gout are not a clinical problem in sickle cell disease in our country. Nevertheless, our findings indicate that kidney function has to be fully explored if serum uric acid level is elevated or significantly deteriorates during follow-up. Serum uric acid level could be an early marker of renal dysfunction in sickle cell disease patients.     

Approche multifactorielle et typologique du concept de fragilité chez les patients hypertendus non contrôlés. Enquête Eclat

Objective

The aim of the Eclat survey was to evaluate the frequency of frailty in uncontrolled hypertensives and to individualize different frailty profiles.

Patients and methods

This was an observational, prospective, longitudinal survey conducted in the cohort of uncontrolled hypertensive patients aged 55 years or more. Morbid events having occurred between two visits at a 6-month interval were reported. Patients with at least one event were considered to be frail. Predictive factors of at least one event were identified (logistic regression). The analysis was completed by a typological analysis (principal components analysis and clustering).

Results

At least one event occurred in 211 (9%) of 2306 patients (males 55%, 67 ± 9 years old, blood pressure [BP] = 160 ± 11/93 ± 8 mmHg, diabetes 23%): cardiovascular (1.7%), gerontological (5.5%), onset of diabetes (1.3%), worsening of renal impact (2%). Three frailty profiles were identified: patients at low risk (n = 1507, event rate = 6%), with neither cardiovascular risk factors nor target organ damage; patients at moderate risk (n = 335, event rate = 12%) with numerous risk factors but no target organ damage and patients at high risk (n = 243, event rate = 23%), the older ones, in bad general condition, with target organ damage, sensorial deficits and cognitive disorders. In a population of uncontrolled hypertensives aged 55 years or more, 9% could be considered as frailty.

Conclusion

Therapeutic measures might be adapted according to the frailty profile of the patient. With respect to treatment management, healthcare behaviour could differ depending on these frailty profiles.     

Additive effect of diets and training on total Insulin-like Growth Factor-1 (IGF-1) in rats

Objectives

Although it is known that circulating levels of insulin-like growth factor-1 (IGF-1) are influenced by both physical exercise and dietary intake separately, there is little information regarding the additive effect of diets and training on IGF-1 regulation. To test this, we examined the combined effect of 30 days of two different diets (high-protein and high-carbohydrate) and exercise training on total IGF-1.

Materials and methods

The study was carried out with four groups of rats; the sedentary group with standard diet (SS) (control group), standard diet with exercise (SE), high-protein diet with exercise (PE) and high-carbohydrate diet with exercise (CE). Serum IGF-1, insulin, corticosterone were analyzed.

Results

IGF-1 concentrations were decreased by exercise training (p < 0.001) and only with protein diet (p < 0.05). Physical training, with and without diet, decreased body weight and food intake (p < 0.01) and increased corticosterone levels (p < 0.05). Carbohydrate diet did not cause major hormonal and metabolic alterations.

Conclusion

The main result of this study was the decreased levels of IGF-1 in spite of high-protein diet, which is known to enhance IGF-1 secretion, and the little changes with carbohydrate diet. This may be related to the negative energy balance as a result of the catabolic state induced by exercise training and decreased calorie intake in protein diet. Thus, it can be concluded that the caloric restriction, regardless of dietary composition, decreased IGF-1 secretion.