Increased glucose excursion in cystic fibrosis and its association with a worse clinical status

BACKGROUND: Abnormal glucose tolerance is a frequent co-morbidity in cystic fibrosis patients (CF), and is associated with a worse prognosis. The objectives are to investigate (a) the relative contribution of insulinopenia and insulin resistance (IR) for glucose tolerance and (b) the association between various glucose parameters and CF clinical status. METHODS: Oral glucose tolerance tests were performed in 114 consecutive CF patients not known to be diabetic as well as 14 controls similar for age and BMI. RESULTS: Abnormal glucose tolerance was found in 40% of patients with CF: 28% had impaired glucose tolerance (IGT) and 12% had new cystic fibrosis related diabetes (CFRD). Compared to control subjects, all CF patients were characterized by an increased glucose excursion (AUC). While reduced early insulin release characterised CF, IGT and CFRD patients also present IR thus both mechanisms significantly contribute to glucose tolerance abnormalities. Increased glucose AUC and reduced early insulin release but not glucose tolerance categories were associated with a reduced pulmonary function (FEV(1)). CONCLUSION: In CF, early insulin secretion defect but also IR contribute to glucose intolerance. Early in the course of the disease, increased glucose AUC and reduced early insulin secretion are more closely associated with a worse clinical status than conventional glucose tolerance categories.     

Platelet apoptosis in paediatric immune thrombocytopenia is ameliorated by intravenous immunoglobulin

To evaluate the role of intravenous immunoglobulin (IVIg) in platelet apoptosis in paediatric immune thrombocytopenia, we investigated the platelets of 20 paediatric patients with acute immune thrombocytopenia (ITP), before and after IVIg treatment. Healthy children with platelet counts in the normal range and children with thrombocytopenia due to chemotherapy were enrolled as controls. All ITP patients presented with platelet counts <20 × 10⁹/l and bleeding symptoms. Markers of apoptosis, including activated caspase‐3, ‐8 and ‐9, phosphatidylserine (PS) exposure, mitochondrial inner membrane potential (ΔΨm), as well as platelet‐derived microparticle formation, were analysed by flow cytometry. After IVIg treatment, platelet counts increased to >20 × 10⁹/l in all patients. ITP patients had significantly increased proportions of platelets with activated caspase‐3, ‐8 and ‐9, with PS exposure, and with decreased ΔΨm, and demonstrated increased microparticle formation. Except for ΔΨm, these markers for apoptosis were reduced by IVIg treatment. Platelets of children with thrombocytopenia after chemotherapy also demonstrated increased microparticle formation and decreased ΔΨm, but no activation of caspases 3, 8 and 9 or PS exposure. In conclusion, in acute paediatric ITP, enhanced platelet apoptosis is seen at diagnosis that normalizes after IVIg treatment.     

MicroRNAs as components of regulatory networks controlling erythropoiesis

Over the last two decades, the role of microRNAs has been extensively investigated, and it has become clear that these small non-coding RNAs play an essential role in several biological processes including erythropoiesis and that their dysregulation is associated with pathologies. Recent technical innovations have considerably advanced this field and allowed extensive study of microRNA expression and regulation in a variety of cell types. In erythropoiesis, microRNA regulation is involved at defined stages and promotes either stem cell proliferation or erythroid cell differentiation. In this review, while recapitulating the maturation steps of erythroid cells, we discuss the progresses in our understanding of microRNA regulation in the erythroid lineage and their contribution to erythroid disorders.     

Comparaison de l’Airtraq, du X-Lite et du laryngoscope standard pour la chirurgie thyroïdienne: une étude clinique randomisée

Purpose

To compare the performance of the Airtraq, X-Lite, and direct laryngoscopes for tracheal intubation for elective thyroid surgery.

Methods

In this randomized prospective study, Patients who were ASA (American Society of Anesthesiologists) I or II physical status I or II and patients undergoing thyroid surgery were included in this randomized prospective study. Patients with attributes for difficult intubation criteria were excluded. After induction of anesthesia with fentanyl, propofol, and cisatracurium, patients were randomized into three groups according to the intubating device used: Airtraq laryngoscope (Airtraq), X-Lite video laryngoscope (X-lLite), and direct laryngoscope with a Macintosh blade (Direct). The primary outcome measurement was the time needed for tracheal intubation. Secondary outcomes included intubation difficulty score (IDS), Cormack-Lehane classification, as well as hemodynamic and respiratory effects.

Results

One hundred and five patients were included. Mean (standard deviation) time for intubation was 28.2 (2.1) sec in the Airtraq group vs 36.6 (3.7) sec in the X-Lite group (P < 0.001), and 41.1 (4.4) sec in the Direct group (P < 0.001). Compared with to the direct laryngoscope, the Airtraq provided better visualization of the glottis (P = 0.003) with fewer attempts (P < 0.001) and lower IDS (P < 0.001). The intubation difficulty score was lower with the Airtraq than with the X-Lite (P = 0.003). Patients in the X-Lite and Direct groups showed more hemodynamic variations than those in the Airtraq group. There was only one failed intubation, in the direct group.

Conclusion

In thyroid surgery, the Airtraq and X-Lite laryngoscopes decrease time to intubation when compared with direct laryngoscopy.     

Le burn out, conséquences et solutions : enquête chez les personnels d’anesthésie–réanimation de quatre hôpitaux universitaires marocains

Background

Burn out syndrome consists in physical and mental exhaustion observed in professionals whose work involves continuous contact with other people in response to chronic stress. Anesthesists reanimators staff are considered to be vulnerable to experiencing burn out. After analyzing the prevalence and risk factors in an anterior article, we tried through this work to evaluate the consequences of burn out and to have a preventive or curative approach for this syndrome among medical and paramedical staff in intensive care unit.

Methods

A multicenter analytical cross-sectional study was conducted among practitioners in many Anesthesia and Intensive Care units in Moroccan University Hospitals (Rabat, Casablanca, Fez and Marrakech). Practitioners were invited to fill a self-questioning which envisaged eventual consequences of burn out, and they were invited to suggest solutions to this problem and to express their comments on subject.

Results

Our 202 practitioners who present burn out, accused irritability, discontent, and angriness in respectively 34,3%, 41,7%, and 34,1% case; 59,7% complains sleep confusion, 60,68% developed addict attitudes and 55,5% have relational problem. Proposed resolutions stressed the importance of the optimization of work organization and the motivation of personal, one of the precautionary lanes would consist on the combination of different therapeutic approaches (individual, collective and organizational).

Discussion/Conclusion

Burn out appears to be a reality in intensive care unit. Introduction of preventive strategies, while underlining the importance of work organization and communication seem to be necessary.