Physical activity,functional ability,and disease activity in children and adolescents with juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA) is a chronic condition known to cause pain-related complications in youth and affect children’s physical functioning. There is no data in Arabic children with JIA about the impact of illness upon their physical activity. The objective of this study was to explore physical activity (PA) in children and adolescents with JIA compared with a healthy population and to examine associations between PA, functional ability, and disease activity. Our study included patients with JIA and group control aged between 8 and 17 years. The diagnosis was used according to the International League of Association of Rheumatology (ILAR) criteria 2001. Sociodemographic data and clinical features were collected. Physical activity level and energy expenditure were assessed with a 1-day activity diary and the metabolic equivalent (MET), respectively. Functional ability was assessed with the Moroccan version of the Childhood Health Assessment Questionnaire (CHAQ). Disease activity was measured using the Juvenile Arthritis Disease Activity Score (JADAS). Fifty patients and 50 controls were included (mean?±?SD age 11.5?±?3.3 and 10.5?±?3.8 years, respectively; p?=?0.49) with masculine predominance n?=?30 (59.6 %) and n?=?29 (58 %), respectively (p?=?0.26). The median disease duration was 4.3 years (2–5). The median analog scale (VAS) pain was 20 (10–40). Fourteen patients (28 %) had an active disease. Patient population consisted in majority of oligoarticular arthritis (28 %), 14 patients. The mean of energy expenditure and physical activity were significantly higher in the JIA group. The JIA group spent more time in bed and less time on moderate to vigorous PA than the control group. There is no significant relationship between PA, functional ability, and disease activity. Our study suggests that children and adolescents with JIA have low PA levels and are at risk of losing the benefits of PA. Low PA is not related to functional ability, disease duration, and disease activity in children and adolescent with JIA. A large cohort is necessary to confirm these results.     

Acute kidney injury related to pregnancy in developing countries: etiology and risk factors in an intensive care unit

Background: The aim of this study was to determine etiologies, risk factors and prognosis of pregnancy-related acute kidney injury (AKI) in an intensive care unit. Methods: Patients included in this retrospective study had a gestational age exceeding 20 weeks of amenorrhea. We defined and classified AKI according to the criteria of the RIFLE classification. Patients were separated into 2 groups: group 1 with AKI and group 2 without AKI. Results: Obstetric admission cases (n=137) were compiled, including 46 cases of AKI. Comparison of the different variables between groups 1 and 2 revealed a statistically significant difference regarding home birth (p=0.004), severe hypotension (p=0.007), icterus (p=0.001), oligoanuria (p=0.001), hyperuricemia (p=0.01), thrombopenia (p=0.001) and hepatic cytolysis (p=0.001). The incidences of HELLP syndrome, abruptio placentae and disseminated intravascular coagulation were higher in the AKI group. Maternal mortality was 28.3% in group 1. Conclusion: The incidence of AKI in developing countries ranges from 4% to 36% depending on the study. In India and Pakistan, cases of pregnancy-related AKI occur mainly during the first trimester of pregnancy and are related to severe states of sepsis. In Morocco, AKI occurs mainly in the third trimester in a context of hypertensive disorders. Maternal mortality varies between 6% and 30% depending on the study. AKI is a frequently occurring complication in developing countries. It is reversible as shown by total recovery of renal function, but this depends on early and appropriate diagnosis and treatment. Nevertheless, the best treatment remains prevention.     

Ultrasound measurements of brain tissue pulsatility correlate with the volume of MRI white-matter hyperintensity

White-matter hyperintensity (WMH) is frequently seen in magnetic resonance imaging (MRI), but the complete physiopathology of WMH remains to be elucidated. In this study, we sought to determine whether there is an association between the maximum brain tissue displacement (maxBTD), as assessed by ultrasound, and the WMH, as observed by MRI. Nine healthy women aged 60 to 85 years underwent ultrasound and MRI assessments. We found a significant negative correlation between maxBTD and WMH (ρ=−0.86, P<0.001), suggesting a link between cerebral hypoperfusion and WMH.     

Predictive model of biliocystic communication in liver hydatid cysts using classification and regression tree analysis

Background

Conservative treatment of uncomplicated or mild diverticulitis usually includes antibiotic therapy. It is, however, uncertain whether patients with acute diverticulitis indeed benefit from antibiotics. In most guidelines issued by professional organizations antibiotics are considered mandatory in the treatment of mild diverticulitis. This advice lacks evidence and is merely based on experts' opinion. Adverse effects of the use of antibiotics are well known, including allergic reactions, development of bacterial resistance to antibiotics and other side-effects.

Methods

A randomized multicenter pragmatic clinical trial comparing two treatment strategies for uncomplicated acute diverticulitis. I) A conservative strategy with antibiotics: hospital admission, supportive measures and at least 48 hours of intravenous antibiotics which subsequently are switched to oral, if tolerated (for a total duration of antibiotic treatment of 10 days). II) A liberal strategy without antibiotics: admission only if needed on clinical grounds, supportive measures only. Patients are eligible for inclusion if they have a diagnosis of acute uncomplicated diverticulitis as demonstrated by radiological imaging. Only patients with stages 1a and 1b according to Hinchey's classification or "mild" diverticulitis according to the Ambrosetti criteria are included. The primary endpoint is time-to-full recovery within a 6-month follow-up period. Full recovery is defined as being discharged from the hospital, with a return to pre-illness activities, and VAS score below 4 without the use of daily pain medication. Secondary endpoints are proportion of patients who develop complicated diverticulitis requiring surgery or non-surgical intervention, morbidity, costs, health-related quality of life, readmission rate and acute diverticulitis recurrence rate. In a non-inferiority design 264 patients are needed in each study arm to detect a difference in time-to-full recovery of 5 days or more with a power of 85% and a confidence level of 95%. With an estimated one percent of patients lost to follow up, a total of 533 patients will be included.

Conclusion

A clinically relevant difference of more than 5 days in time-to-full recovery between the two treatment strategies is not expected. The liberal strategy without antibiotics and without the strict requirement for hospital admission is anticipated to be more a more cost-effective approach.

Trial registration

Trial registration number: NCT01111253     

Prevalence of the mitochondrial A 1555G mutation in Moroccan patients with non-syndromic hearing loss

Mutations in mitochondrial DNA (mtDNA), especially the A1555G transition in the 12S rRNA gene, are one of the causes of both aminoglycoside-induced and non-syndromic sensorineural hearing loss.

Objective

The aim of this study was to determine the prevalence of the A1555G mitochondrial mutation in Moroccan patients.

Methods

We performed molecular characterization by PCR-RFLP and direct sequencing of one hundred and sixty four patients (84 unrelated familial and 80 sporadic cases) with a congenital sensorineural non-syndromic hearing loss and one hundred normal hearing controls for the occurrence of the A1555G mutation.

Results

Mutational analysis of the mtDNA showed the presence of the homoplasmic A1555G mutation in three families, leading to a frequency of 3.6% similar to that reported for European-populations. No A1555G mutation was detected in sporadic and controls cases. However, we detected in twenty normal hearing controls a novel polymorphism A1557C, which was not found in patient samples. We further evidenced the presence of the A1438G mitochondrial polymorphism in four patients with sensorineural hearing loss and in five controls.

Conclusion

Our results show that the occurrence of the A1555G mutation in hearing impaired patient's accounts for 3.6% in a Moroccan patients and those novel mtDNA polymorphisms might contribute to a novel sub-haplogroup specific of the Magrheb.