John Goldman Fellowships for Future Science

The level of circulating platelet‐, erythrocyte‐, leucocyte‐ and endothelial‐derived microparticles detected by high‐sensitivity flow cytometry was investigated in 37 β‐thalassaemia major patients receiving a regular transfusion regimen. The phospholipid procoagulant potential of the circulating microparticles and the microparticle‐dependent tissue factor activity were evaluated. A high level of circulating erythrocyte‐ and platelet‐microparticles was found. In contrast, the number of endothelial microparticles was within the normal range. Platelet microparticles were significantly higher in splenectomized than in non‐splenectomized patients, independent of platelet count (P < 0·001). Multivariate analysis indicated that phospholipid‐dependent procoagulant activity was influenced by both splenectomy (P = 0·001) and platelet microparticle level (P < 0·001). Erythrocyte microparticles were not related to splenectomy, appear to be devoid of proper procoagulant activity and no relationship between their production and haemolysis, dyserythropoiesis or oxidative stress markers could be established. Intra‐microparticle labelling with anti‐HbF antibodies showed that they originate only partially (median of 28%) from thalassaemic erythropoiesis. In conclusion, when β‐thalassaemia major patients are intensively transfused, the procoagulant activity associated with thalassaemic erythrocyte microparticles is probably diluted by transfusions. In contrast, platelet microparticles, being both more elevated and more procoagulant, especially after splenectomy, may contribute to the residual thrombotic risk reported in splenectomized multi‐transfused β‐thalassaemia major patients.     

An Epidemiological and Clinical Study of Transaminase Levels and Hepatitis B Antibodies in 1,100 Blood Donors

In order to provide epidemiological and clinical information on surrogate testing of blood donations, the respective prevalences of serum hepatitis B virus (HBV) markers and elevated transaminase levels were studied in 1,100 blood donors according to their geographic origin and socioeconomic level. The frequency of serum HBV markers varied as a function of HBV endemicity in the country of origin; however, it was inversely correlated (p less than 0.05) to the socioeconomic level of the donors, even in those originating from countries of low HBV endemicity. There was no association between serum HBV markers and the increased transaminase level which was observed in 48 (4.3%) donors. Twenty-five of these accepted further clinical evaluation. A diagnosis appeared probable in 12 of the 25: alcohol in 5; drugs in 6; non-A, non-B hepatitis in 1. Seven of the remaining 13 subjects were more than 25% above ideal body weight. Transaminase activities determined at the time of clinical assessment were normal in 14. In addition, serum HBV DNA was found in 5 of 247 donors, even in the absence of any usual HBV marker and/or hypertransaminasemia. This could account for the few cases of B and B-like posttransfusion hepatitis which are known to still occur despite careful HBsAg screening of blood donors.     

Consumption of Argan Oil Improves Anti‐Oxidant and Lipid Status in Hemodialysis Patients

Objective: Virgin Argan oil (VAO) is of interest in oxidative stress and lipid profile because of its fat composition and antioxidant compounds. We investigated the effect of VAO consumption on lipid profile and antioxidant status in hemodialysis patients after a 4‐week period of consumption. Methods: In a crossover, controlled trial, 37 patients (18 men, 19 women) with end‐stage renal disease on maintenance hemodialysis, were randomly assigned to a 4‐week VAO diet. Fasting plasma lipids, vitamin E and oxidized LDL (ox‐LDL) were analyzed. Malondialdehyde (MDA) was determined before and after hemodialysis session. Results: There was no significant change in serum total cholesterol and ox‐LDL. However, VAO consumption decreased the levels of triglyceride (p = 0.03), total cholesterol (p = 0.02) and low‐density lipoprotein (p = 0.03) and increased the levels of high‐density lipoprotein (p = 0.01). Plasma vitamin E contents significantly increased from baseline only in VAO‐group (p < 0.001). Hemodialysis session increased MDA levels, but the increase in VAO group was less than in control group. Conclusion: VAO consumption improved lipid profile and oxidative stress status in hemodialysis patients. Copyright © 2015 John Wiley & Sons, Ltd.     

New approaches to the medical treatment of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a common disorder with a worldwide distribution; it is characterized by abdominal pain and discomfort associated with an alteration of bowel function. The treatment approach for IBS depends on the patient’s presenting symptoms at the time of diagnosis, and treatment is usually directed toward the predominant symptom. In this review we discuss the current approach to the treatment of IBS.     

Insuffisance rénale aiguë révélant une hypothyroïdie auto-immune

Although the clinic picture is often indicative of muscle manifestations in patients with hypothyroidism, signs and symptoms of this condition are variable from simple elevation of serum muscle enzymes with myalgia, muscle weakness, cramps to rhabdomyolysis with acute renal failure which remains a rare event. Thyroid hormones affect the function of almost every body organ, and thyroid dysfunction produces a wide range of metabolic disturbances. Hypothyroidism is associated with significant effects on the kidney which the pathophysiology seems to be multifactorial, but the exact mechanisms remain poorly understood. Hypothyroidism as a cause of renal impairment is usually overlooked, leading to unnecessary diagnostic procedures. The main objective of our observation is to report a case of acute renal failure revealing an autoimmune hypothyroidism in which thyroid hormone substitution led to a significant improvement in muscular, thyroid and renal disorders.     

Remission of steroid- and CyA-resistant nephrotic syndrome using multiple drug immunosuppression

Nephrotic proteinuria in minimal change disease (MCD) is supposed to be due to a circulating factor of immunologic origin. End-stage renal failure occurs if both steroids and immunosuppressive drugs remain ineffective. Three children (2 years, 3 years, and 6 years of age) with secondary steroid-resistant nephrotic syndrome (NS) were included, as they remained resistant to 30 days of treatment with prednisone (60 mg/m² per day), three pulses of methylprednisolone (1 g/1.73 m²) followed by oral administration of CyA 7.5 mg/kg per day over 2 months, and 1 month of intravenous (i.v.) administration of cyclosporine (blood level 500–600 ng/ml). All three patients were partially responsive to methylprednisolone pulses, with an increase of serum albumin by 100%. They were treated with plasma exchanges, cyclophosphamide and cyclosporine A, both given orally, pefloxacin and methylprednisolone pulses followed by orally administered prednisone. All three patients went into remission within 2 to 5 weeks. The character of their NS changed to a steroid-sensitive one. There were no significant side effects from the therapy. They had normal renal function, normal blood pressure and no residual proteinuria. A combination of plasmapheresis and multiple immunosuppressive medications was effective in producing remission of minimal change NS in three children who were previously resistant to glucocorticoids and cyclosporine.     

Consumption analyze of the antihypertensive drugs in Morocco: period 1991-2005

INTRODUCTION: The medical assumption of responsibility of the chronic diseases in Morocco, in particular arterial hypertension, remains problematic. OBJECTIVES: To evaluate the consumption, segmentation and the share of the market of generic antihypertensive drugs during the period: 1991-2005. METHODS: The data were elaborate starting from the declarations of IMS health (Intercontinental Marketing Service) for Morocco. These data related to the sales with only the pharmacies and were expressed as daily defined dose (DDD)/1000 inhabitant-days. RESULTS: The consumption of the antihypertensive drugs increased from 2 to 10 DDD/1000 between 1991 and 2005. The family of diuretics drugs was the most consumed (3.5 DDD/1000) followed by nonassociated beta-blockers (2 DDD/1000) in 2005. The segmentation was primarily represented by the diuretics (34%) and the beta-blockers (20%). The market of generic antihypertensive drugs passed from 3.3% in 1991 to 21.7% in 2005. CONCLUSION: The consumption of the antihypertensive drugs in Morocco remains too low in spite of an increasing tendency to depend especially on the generic drugs.