[SMARCB1-deficient renal medullary carcinoma with supra clavicular revealing location]. / Carcinome médullaire rénal SMARCB1-déficient révélé par une métastase ganglionnaire sus-claviculaire.

We report the case of a 14 year-old teenager who has SC hemoglobinosis and presented with a tumor syndrome with a retro-peritoneal mass, a supraclavicular lymph node and a mid-renal lesion. The microscopic examination revealed an undifferentiated tumor proliferation infiltrating the lymph node parenchyma. This tumor proliferation was INI1/SMARCB1-deficient, and expressed cytokeratins. Given the fact that the histopathological data showed an undifferentiated INI1-deficient carcinoma and that the patient has a kidney lesion and a sickle cell trait, the final diagnosis was lymph node metastasis of SMARCB1-deficient renal medullary carcinoma (OMS 2022).

Binge drinking alongside alcoholic chronic abuse.

Here is reported the case of an adult patient with ethylic cirrhosis associated with spur cell anemia. Moreover, acute vacuolation of leukocytes was observed in relationship with recent binge drinking.

Endothelin A receptor antagonist attenuated renal iron accumulation in iron overload heme oxygenase-1 knockout mice.

Progressive iron accumulation and renal impairment are prominent in both patients and mouse models of sickle cell disease (SCD). Endothelin A receptor (ETA) antagonism prevents this iron accumulation phenotype and reduces renal iron deposition in the proximal tubules of SCD mice. To better understand the mechanisms of iron metabolism in the kidney and the role of the ETA receptor in iron chelation and transport, we studied renal iron handling in a nonsickle cell iron overload model, heme oxygenase-1 (Hmox-1-/-) knockout mice. We found that Hmox-1-/- mice had elevated plasma endothelin-1 (ET-1), cortical ET-1 mRNA expression, and renal iron content compared with Hmox-1+/+ controls. The ETA receptor antagonist, ambrisentan, attenuated renal iron deposition, without any changes to anemia status in Hmox-1-/- mice. This was accompanied by reduced urinary iron excretion. Finally, ambrisentan had an important iron recycling effect by increasing the expression of the cellular iron exporter, ferroportin-1 (FPN-1), and circulating total iron levels in Hmox-1-/- mice. These findings suggest that the ET-1/ETA signaling pathway contributes to renal iron trafficking in a murine model of iron overload.

La prévention et la prise en charge des complications aiguës de l'anémie falciforme.

L'anémie falciforme est une maladie multisystémique chronique qui exige des soins globaux. La falciformation des globules rouges entraîne une hémolyse et une occlusion vasculaire. L'anémie hémolytique, les syndromes douloureux et les atteintes organiques en sont des complications. En raison des profils d'immigration et d'une augmentation du dépistage néonatal, les professionnels de la santé pédiatrique du Canada doivent connaître l'anémie falciforme, tant dans les petits que les grands centres. Le présent document de principes porte sur les principes de prévention, de défense d'intérêts et de traitement rapide des complications aiguës courantes de l'anémie falciforme. Les lignes directrices comprennent l'état actuel du dépistage néonatal, les recommandations en matière de vaccination et de prophylaxie antibiotique et une introduction à l'hydroxyurée, un médicament qui réduit à la fois la morbidité et la mortalité chez les enfants atteints d'anémie falciforme. Des scénarios cliniques démontrent les principes de soins en cas de complications aiguës courantes : les épisodes vaso-occlusifs, le syndrome thoracique aigu, la fièvre, la séquestration splénique, les crises aplasiques et les accidents vasculaires cérébraux. Enfin, les principes de transfusion sanguine sont présentés, de même que les indications de transfusion simple ou d'exsanguinotransfusion.

[Sickle cell disease, a genetic haemoglobin disease]. / La drépanocytose, une maladie génétique de l'hémoglobine.

Sickle cell disease is the number one genetic disease in France in terms of the number of children diagnosed each year in the neonatal period. Throughout their lives, people with sickle cell disease are likely to develop acute complications that require urgent treatment. Chronic complications are more common amongst adults than in children.

Use of pre-ART laboratory screening to identify renal, hepatic and haematological abnormalities in Côte d'Ivoire.

BACKGROUND: High demand for HIV-services and extensive clinical guidelines force health systems in low-resource settings to dedicate resources to service delivery at the expense of other priorities. Simplifying services may reduce the burden on health systems and pre-antiretroviral therapy (ART) laboratory screening is among the services under consideration for simplification. METHODS: We assessed the frequencies of conditions linked to ART toxicities among 34,994 adult, ART-naïve patients with specimens referred to the RETRO-CI laboratory in Abidjan, Côte d'Ivoire between 1998 and 2017. Screening included tests for serum creatinine, alanine aminotransferase (ALT) and haemoglobin (Hb) to identify renal dysfunction (estimated glomerular filtration rate < 50 mL/min), hepatic abnormalities (ALT > 5× upper limit of normal) and severe anaemia (Hb < 6.5 g/dL), respectively. We considered screening results across four eras and identified factors associated with the conditions in question. RESULTS: The prevalence of renal dysfunction, hepatic abnormalities and severe anaemia were largely unchanged over time and just 8.4% of patients had any of the three conditions. Key factors associated with renal dysfunction and severe anaemia were age > 50 years (adjusted odds ratio (aOR): 2.53; 95% confidence interval (CI): 2.19-2.92; P < 0.001) and CD4 < 100 cells/µl (aOR: 2.57; 95% CI: 2.30-2.88; P < 0.001). CONCLUSION: The relative infrequency of conditions linked to toxicity in Côte d'Ivoire supports the notion that simplification of pre-ART laboratory screening may be undertaken with limited negative impact on identification of adverse events. Targeted screening may be a feasible strategy to balance detection of conditions associated with ART toxicities with simplification of services.

CONTEXTE: La forte demande de services VIH et les directives cliniques détaillées obligent les systèmes de santé des pays à faibles ressources à consacrer des ressources à la prestation de services au détriment d'autres priorités. La simplification des services peut réduire la charge pesant sur les systèmes de santé et les analyses de laboratoire avant la thérapie antirétrovirale (ART) fait partie des services envisagés pour la simplification. MÉTHODES: Nous avons évalué la fréquence des conditions liées aux toxicités dues à l'ART chez 34.994 patients adultes naïfs pour l'ART avec des échantillons référés au laboratoire RETRO-CI à Abidjan, en Côte d'Ivoire entre 1998 et 2017. Les analyses comprenaient les tests de créatinine sérique, d'alanine aminotransférase (ALT) et d'hémoglobine (Hb) pour identifier respectivement la dysfonction rénale (débit de filtration glomérulaire estimé <50 mL/min), les anomalies hépatiques (ALT >5x la limite supérieure normale) et l'anémie sévère (Hb <6,5 g/dL). Nous avons examiné les résultats des analyses sur quatre époques et identifié les conditions associées aux conditions en question. RÉSULTATS: La prévalence de la dysfonction rénale, des anomalies hépatiques et de l'anémie sévère est restée largement inchangée au fil du temps et seulement 8,4% des patients présentaient l'une des trois conditions. Les facteurs clés associés à la dysfonction rénale et à l'anémie sévère étaient l'âge >50 ans (odds ratio ajusté (aOR): 2,53; intervalle de confiance (IC) à 95%: 2,19 à 2,92; p <0,001) et les CD4 <100 cellules/µl (aOR: 2,57; IC95%: 2,30 à 2,88; P < 0,001). CONCLUSION: La relativement faible fréquence des conditions liées à la toxicité en Côte d'Ivoire soutient la notion selon laquelle une simplification des analyses de laboratoire pré-ART peut être entreprise avec un impact négatif limité sur l'identification des événements adverses. Le ciblage des analyses peut être une stratégie réalisable pour aligner la détection des conditions associées aux toxicités ART à la simplification des services.

[Intravenous iron supplementation in the elderly patient]. / Supplémentation ferrique par voie intraveineuse chez le patient âgé.

Iron deficiency, absolute or functional, is a common pathology in elderly patients and the way of iron replacement therapy is a recurrent issue. It seems to be necessary to treat by intravenous iron instead of oral therapy because of defective iron absorption or side effects. Depending on the molecule chosen, the modes of administration, whether dilution, dose or rhythm, vary. The major risk of intravenous iron replacement is anaphylaxis, which is very rare, this is why it has to be an hospital administration.

Temporal trends and differential patterns in the prevalence of severe anaemia in India: observations from country-wide haemoglobin determinations 2008-2018.

OBJECTIVES: To assess temporal trends in the occurrence of severe anaemia in India over the past decade, encompassing every state and union territory. METHODS: For the period 2008-09 to 2017-18, annual estimates (%) of severe anaemia (haemoglobin < 7 g/dl) for India were derived from Health Management Information System datasets, along with 95% confidence intervals (CIs) to construct temporal trends. Differential patterns in the distribution of severe anaemia by geography, epidemiological transition level and socio-demographic index values were also investigated. RESULTS: Severe anaemia occurred in 3.29% (95% CI: 3.28-3.30%) of all haemoglobin determinations in India in 2017-18, which was less than a third of the number in 2008-09. This decline (overall 7.8% or 0.78% per year) over the past decade was consistent (χ2trend  = 1 557 296, P < 0.001). Distribution of severe anaemia was heterogeneous between states and union territories (in 2017-18), ranged from < 1% (in Kerala and Lakshadweep) to > 8% (in Telangana). Significant variations were observed according to geographical region (highest in Central zone), epidemiological transition level (highest at higher middle epidemiological transition level) and socio-demographic index (highest at middle socio-demographic index). Severe anaemia burden between rural and urban areas also differed significantly. CONCLUSION: Although the prevalence of severe anaemia has decreased in India over the last decade, it remains substantial and differs widely with respect to geography, epidemiological transition level, and socio-economic conditions. A detailed assessment of the various aetiologies and documentation of their spatial epidemiology is desirable to understand their relative contribution to the severe anaemia burden and to design appropriate interventions.

OBJECTIFS: Evaluer les tendances temporelles de la survenue de l'anémie sévère en Inde au cours de la dernière décennie, couvrant tous les états et territoires de l'union. MÉTHODES: Pour la période 2008-2009 à 2017-2018, les estimations annuelles (%) du nombre d'anémies sévères (hémoglobine <7 g/dL) en Inde ont été calculées à partir des données du système d'information de gestion de la santé, avec des intervalles de confiance à 95% pour établir les tendances temporelles. Les profils différentiels dans la distribution de l'anémie sévère en fonction de la géographie, du niveau de transition épidémiologique et les valeurs des indices sociodémographiques ont également été investigués. RÉSULTATS: Une anémie sévère est survenue dans 3,29% (IC95%: 3,28 - 3,30%) de toutes les déterminations de l'hémoglobine en Inde en 2017-2018, soit moins du tiers du nombre enregistré en 2008-09. Cette baisse (globale de 7,8% ou 0,78% par an) au cours de la dernière décennie était cohérente (χ2 tendance = 1557296, p <0,001). La distribution de l'anémie sévère était hétérogène entre les états et les territoires de l'union (en 2017-2018), allant de <1% (au Kerala et à Lakshadweep) à >8% (à Telangana). Des variations significatives ont été observées selon la région géographique (plus élevée dans la zone centrale), le niveau de transition épidémiologique (le plus élevé au niveau de transition épidémiologique moyenne supérieure) et l'indice sociodémographique (le plus élevé de l'indice sociodémographique moyen). Les zones rurales et urbaines différaient considérablement. CONCLUSION: Bien que la prévalence de l'anémie sévère ait diminué en Inde au cours de la dernière décennie, elle reste importante et diffère considérablement en ce qui concerne la géographie, le niveau de transition épidémiologique et les conditions socioéconomiques. Une évaluation détaillée des différentes étiologies et de leur épidémiologie spatiale est souhaitable pour comprendre leur contribution relative à la charge de l'anémie sévère et pour concevoir des interventions appropriées.

Dysfunction of the auditory system in sickle cell anaemia: a systematic review with meta-analysis.

OBJECTIVES: To describe the occurrence of both peripheral and central auditory system dysfunction in sickle cell anaemia (SCA) patients and discuss the different mechanisms hypothesised to be responsible for these alterations. METHODS: An electronic search was conducted using PubMed Central® (MEDLINE), LILACS® and Scopus® databases. This systematic review was performed in accordance with the PRISMA statement. Original observational studies that utilised audiological tests for auditory system evaluations in SCA were included. RESULTS: A total of 183 records were found in the databases searched. Twenty-one of these studies met the inclusion criteria. Pooled prevalence of sensorineural hearing loss (SNHL) was 20.5% (CI: 10.3-33%). Retrocochlear involvement was detected with the auditory brainstem response, which assesses integrity of the cochlea, 8th cranial nerve and brainstem structures. In addition, the increase in otoacoustic emission amplitudes in SCA patients indicates changes in cochlear micromechanics and precedes the expression of a detectable cochlear pathology. CONCLUSION: The prevalence of the SNHL is higher than in the general population. Dysfunction of the auditory system may be present in SCA patients, with the most probable mechanism being the presence of circulatory disturbances resulting from the chronic inflammatory state of the disease.

DYSFONCTIONNEMENT DU SYSTÈME AUDITIF DANS L'ANÉMIE FALCIFORME: REVUE SYSTÉMATIQUE ET MÉTA-ANALYSE: OBJECTIFS: Décrire l'apparition de dysfonctionnements du système auditif périphérique et central chez les patients atteints d'anémie falciforme (AF) et discuter des différents mécanismes supposés responsables de ces altérations. MÉTHODES: Une recherche électronique a été effectuée dans les bases de données PubMed Central® (MEDLINE), LILACS® et Scopus® . Cette revue systématique a été réalisée conformément au PRISMA Statement. Des études observationnelles originales utilisant des tests audiologiques pour évaluer le système auditif dans l'AF ont été incluses. RÉSULTATS: Un total de 183 enregistrements ont été trouvés dans les bases de données consultées. Vingt et une de ces études répondaient aux critères d'inclusion. La prévalence poolée de la perte auditive neurosensorielle (SNHL) était de 20,5% (IC: 10,3% à 33%). L'atteinte rétrocochléaire a été détectée avec la réponse du tronc cérébral auditif, qui évalue l'intégrité de la cochlée, du huitième nerf crânien et de la structure du tronc cérébral. De plus, l'augmentation des amplitudes des émissions otoacoustiques chez les patients atteints de l'AF indique des modifications de la micromécanique cochléaire et précède l'expression d'une pathologie cochléaire détectable. CONCLUSION: La prévalence de la SNHL est plus élevée que dans la population générale. Un dysfonctionnement du système auditif peut être présent chez les patients AF, le mécanisme le plus probable étant la présence de troubles circulatoires résultant de l'état inflammatoire chronique de la maladie.

Recovering sustainability after a health crisis in aquatic animals.

Chile faced a severe aquatic animal health crisis in 2007 that affected the production of Atlantic salmon (Salmo salar) after an outbreak of infectious salmon anaemia (ISA). The outbreak had a considerable national economic impact. The response was led by the Competent Authority, the National Fisheries and Aquaculture Service (Sernapesca), which immediately implemented surveillance and control actions to mitigate the crisis. At the end of the initial response, the Competent Authority, together with the industry, set out a roadmap to return to sustainable salmon production. The success of the response was due to early detection and the implementation of biosecurity and control measures at all stages of production and control. These measures underpin the sanitary management model for aquaculture. The Chilean Veterinary Service has analysed critical health measures for salmon production and concluded that there has been an improvement in fish health, as evidenced by decreased mortalities, reduced use of antimicrobials, and improved management and control of prevalent diseases, such as salmon rickettsial syndrome (piscirickettsiosis), caligidosis and ISA. Improvements in health have contributed to increased harvests over time, with the largest monthly harvest for Atlantic salmon being achieved in January-February 2018, with 120,000 tonnes. The ISA crisis provided salutary lessons for the continued recovery and sustainability of Chile's salmon sector. The crisis highlighted the importance of strengthened Veterinary Services and public-private links, as well as a collaborative relationship with research entities and training centres. It was also important to enact new regulations to ensure recovery and sustainability. Fundamentally, the response to this crisis was based upon having good baseline surveillance already in place, supported by a Veterinary Service trained to manage emergency disease outbreaks.

Le Chili a fait face à une crise sanitaire majeure chez les animaux aquatiques suite à la survenue en 2007 d'un foyer d'anémie infectieuse du saumon qui a affecté la production de saumons atlantiques (Salmo salar). L'impact économique de ce foyer a été considérable à l'échelle nationale. Les mesures d'intervention d'urgence ont été conduites par l'autorité compétente, le Service national chilien de la pêche et de l'aquaculture (Sernapesca) qui a immédiatement mis en place des mesures de surveillance et de lutte afin d'atténuer la crise. À l'issue de cette réponse initiale, l'autorité compétente a élaboré une feuille de route avec le concours du secteur salmonicole afin de restaurer la durabilité de la production de saumons. La réussite de cette réponse est due aux capacités de détection précoce et à la mise en œuvre de mesures de biosécurité et de suivi à chaque étape de la production et des contrôles. Ces mesures constituent la base du modèle de gestion sanitaire en aquaculture. Les Services vétérinaires chiliens ont analysé les mesures sanitaires critiques applicables aux élevages de saumons et conclu à une nette amélioration de la santé des poissons, attestée par la baisse de la mortalité, la réduction des quantités d'agents antimicrobiens utilisés et une gestion et un contrôle plus efficaces des maladies présentes dans le pays, en particulier la piscirickettsiose des salmonidés, la caligidose et l'anémie infectieuse du saumon. L'amélioration de la situation sanitaire a contribué à l'augmentation progressive des volumes de production, qui pour le saumon atlantique ont atteint leur plus haut niveau mensuel en janvier-février 2018, avec 120 000 tonnes produites. La crise due à l'anémie infectieuse du saumon a permis de tirer de précieux enseignements qui permettront une récupération durable du secteur salmonicole au Chili. La crise a mis en évidence l'importance de Services vétérinaires renforcés et des partenariats public­privé ainsi que des liens de collaboration avec les institutions de recherche et les centres de formation. L'élaboration d'une nouvelle réglementation a également joué un rôle pour assurer la récupération et la durabilité. Essentiellement, la réponse à cette crise a reposé sur la qualité du système de surveillance déjà en place et sur le soutien de Services vétérinaires formés à la gestion des urgences liées à des foyers de maladie.

Chile hizo frente a una importante crisis sanitaria que se presentó en 2007 y afectó a la producción del salmón del Atlántico (Salmo salar) a raíz de un brote de anemia infecciosa del salmón (ISA). El brote tuvo un gran impacto económico para el país. La repuesta fue dirigida por la autoridad competente, el Servicio Nacional de Pesca y Acuicultura (Sernapesca), que implementó de inmediato medidas de vigilancia y control para mitigar la crisis. Una vez abordados todos los aspectos iniciales de la respuesta inmediata, la autoridad competente, en conjunto con la industria, elaboró una hoja de ruta con el objetivo de mantener una producción sostenible. El éxito de la respuesta se debe a las capacidades de detección temprana y a las medidas de bioseguridad y de vigilancia implementadas en cada etapa del proceso de producción y de control. Estas medidas constituyen la base de la gestión sanitaria de la acuicultura. En base al análisis de las medidas sanitarias aplicables al sector de la salmonicultura realizado por el Servicio Veterinario de Chile, se concluyó que la situación sanitaria había mejorado en los distintos aspectos críticos para esta producción, tales como una evidente disminución de la mortalidad, disminución del uso de antimicrobianos, mejora en la prevalencia y el control de las principales enfermedades prevalentes en la salmonicultura, como piscirickettsiosis, caligidosis e ISA. La mejora de la situación sanitaria contribuyó a la tendencia al alza respecto de las cosechas, alcanzando el máximo mensual de cosechas para el salmón del Atlántico en el mes de enero-febrero 2018, con 120 000 toneladas. Como lecciones aprendidas en términos de recuperación y sostenibilidad del sector de producción del salmón, es importante señalar que, ante la presentación de la crisis, se generó una oportunidad de potenciar a los Servicios Veterinarios, estrechar los vínculos público-privados y desarrollar la colaboración con entidades de investigación y centros de formación. También fue importante promulgar nuevas regulaciones para garantizar la recuperación y la sostenibilidad. Fundamentalmente, la respuesta a esta crisis se basó en contar con una buena vigilancia de referencia ya implementada y con el apoyo de un Servicio Veterinario capacitado para manejar las emergencias debidas a brotes de enfermedades.

[Complications of body lifts]. / Complications des body lifts.

Many complications can occur after body lift surgery if the surgeon does not follow the rules. These complications can be general or only local and aesthetic but anyway very difficult to fix. Therefore, the surgeon must know the very efficient ways to avoid them. We will describe more precisely acute anemia, fat necrosis followed with infection and wound dehiscence, violin deformation and finally intergluteal groove lengthening.

Malaria exacerbates inflammation-associated elevation in ferritin and soluble transferrin receptor with only modest effects on iron deficiency and iron deficiency anaemia among rural Zambian children.

OBJECTIVE: In 4- to 8-year-old Zambian children (n = 744), we evaluated the effects of adjusting for inflammation (α1-acid glycoprotein >1 g/l), with or without additional adjustment for malaria, on prevalence estimates of iron deficiency (ID) and iron deficiency anaemia (IDA) during low malaria (LowM) and high malaria (HighM) transmission seasons. METHODS: To estimate adjustment factors, children were classified as: (i) reference (malaria negative without inflammation), (ii) inflammation without malaria (I), (iii) malaria without inflammation (M) and (iv) inflammation with malaria (IM). We estimated the unadjusted ID or IDA prevalence, and then adjusted for inflammation alone (IDI or IDAI ) or inflammation and malaria (IDIM or IDAIM ). RESULTS: Mean ferritin was 38 (reference), 45 (I), 43 (M) and 54 µg/l (IM) in LowM, increasing to 44, 56, 96 and 167 µg/l, respectively, in HighM. Corresponding mean sTfR was 6.4, 6.9, 7.9 and 8.4 mg/l in LowM, increasing to 8.2, 9.2. 8.7 and 9.7 mg/l in HighM. Ferritin-based ID, IDI and IDIM were 7.8%, 8.7% or 9.1%, respectively, in LowM and 4.6%, 10.0% or 11.7%, respectively, in HighM. Corresponding soluble transferrin receptor (sTfR)-based estimates were 27.0%, 24.1% and 19.1%, respectively, in LowM, increasing to 53.6%, 46.5% and 45.3%, respectively, in HighM. Additional adjustment for malaria resulted in a ~1- to 2-percentage point change in IDA, depending on biomarker and season. CONCLUSIONS: In this population, malaria substantially increased ferritin and sTfR concentrations, with modest effects on ID and IDA prevalence estimates.

Consequences of prenatal geophagy for maternal prenatal health, risk of childhood geophagy and child psychomotor development.

OBJECTIVE: To investigate the relationship between prenatal geophagy, maternal prenatal haematological indices, malaria, helminth infections and cognitive and motor development among offspring. METHODS: At least a year after delivery, 552 of 863 HIV-negative mothers with singleton births who completed a clinical trial comparing the efficacy of sulfadoxine-pyrimethamine and mefloquine during pregnancy in Allada, Benin, responded to a nutrition questionnaire including their geophagous habits during pregnancy. During the clinical trial, helminth infection, malaria, haemoglobin and ferritin concentrations were assessed at 1st and 2nd antenatal care visits (ANV) and at delivery. After the first ANV, women were administered daily iron and folic acid supplements until three what? post-delivery. Singleton children were assessed for cognitive function at age 1 year using the Mullen Scales of Early Learning. RESULTS: The prevalence of geophagy during pregnancy was 31.9%. Pregnant women reporting geophagy were more likely to be anaemic (AOR = 1.9, 95% CI [1.1, 3.4]) at their first ANV if they reported geophagy at the first trimester. Overall, prenatal geophagy was not associated with maternal haematological indices, malaria or helminth infections, but geophagy during the third trimester and throughout pregnancy was associated with poor motor function (AOR = -3.8, 95% CI [-6.9, -0.6]) and increased odds of geophagous behaviour in early childhood, respectively. CONCLUSIONS: Prenatal geophagy is not associated with haematological indices in the presence of micronutrient supplementation. However, it may be associated with poor child motor function and infant geophagy. Geophagy should be screened early in pregnancy.

High folate levels are not associated with increased malaria risk but with reduced anaemia rates in the context of high-dosed folate supplements and intermittent preventive treatment against malaria in pregnancy with sulphadoxine-pyrimethamine in Benin.

OBJECTIVES: To investigate whether high-dosed folate supplements might diminish the efficacy of malaria intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) in a cohort of pregnant women in Benin, where malaria is holoendemic. METHODS: We followed 318 women during the entire pregnancy and analysed haematological and Plasmodium falciparum indicators in the context of an intermittent preventive treatment trial in Benin. During the follow-up, women received two-dose IPTp (1500/75 mg of SP per dose) at the maternity clinic and 600 mg of albendazole, 200 mg ferrous sulphate and 5 mg folic acid per day for home treatment. RESULTS: High folate levels were not associated with increased malaria risk (adjusted OR (aOR) = 0.51 (95% CI: 0.17; 1.56, P-value = 0.24)), nor with increased P. falciparum density (beta coefficient = -0.26 (95% CI: -0.53; 0.02), P-value = 0.07) in a randomised trial of IPTp in Benin. On the contrary, higher iron levels were statistically associated with increased odds of a positive blood smear (aOR = 1.7 95% CI (1.2; 2.3), P-value < 0.001) and P. falciparum parasite density (beta coefficient = 0.2 95% CI (0.1; 0.3), P-value < 0.001). High folate levels were statistically associated with decreased odds of anaemia (aOR = -0.30 95% CI (0.10; 0.88), P-value = 0.03). CONCLUSIONS: High folate levels are not associated with increased malarial risk in a prospective longitudinal cohort in the context of both iron and high-dosed folate supplements and IPTp. They are associated with reduced risk of anaemia, which is particularly important because iron, also given to treat anaemia, might be associated with increased malaria risk.

Short-term effects of hemodiafiltration versus conventional hemodialysis on erythrocyte performance.

Hemodiafiltration (HDF) is a renal replacement therapy that is based on the principles of diffusion and convection for the elimination of uremic toxins. A significant and increasing number of end-stage renal disease (ESRD) patients are treated with HDF, even in the absence of definite and conclusive survival and anemia treatment data. However, its effects on red blood cell (RBC) physiological features have not been examined in depth. In this study, ESRD patients under regular HDF or conventional hemodialysis (cHD) treatment were examined for RBC-related parameters, including anemia, hemolysis, cell shape, redox status, removal signaling, membrane protein composition, and microvesiculation, in repeated paired measurements accomplished before and right after each dialysis session. The HDF group was characterized by better redox potential and suppressed exovesiculation of blood cells compared with the cHD group pre-dialysis. However, HDF was associated with a temporary but acute, oxidative-stress-driven increase in hemolysis, RBC removal signaling, and stomatocytosis, probably associated with the effective clearance of dialyzable natural antioxidant components, including uric acid, from the uremic plasma. The nature of these adverse short-term effects of HDF on post-dialysis plasma and RBCs strongly suggests the use of a parallel antioxidant therapy during the HDF session.

Anaemia in HIV-infected pregnant women receiving triple antiretroviral combination therapy for prevention of mother-to-child transmission: a secondary analysis of the Kisumu breastfeeding study (KiBS).

OBJECTIVE: The prevalence of anaemia during pregnancy is estimated to be 35-75% in sub-Saharan Africa and is associated with an increased risk of maternal mortality. We evaluated the frequency and factors associated with anaemia in HIV-infected women undergoing antiretroviral (ARV) therapy for prevention of mother-to-child transmission (PMTCT) enrolled in The Kisumu Breastfeeding Study 2003-2009. METHODS: Maternal haematological parameters were monitored from 32 to 34 weeks of gestation to 2 years post-delivery among 522 enrolled women. Clinical and laboratory assessments for causes of anaemia were performed, and appropriate management was initiated. Anaemia was graded using the National Institutes of Health Division of AIDS 1994 Adult Toxicity Tables. Data were analysed using SAS software, v 9.2. The Wilcoxon two-sample rank test was used to compare groups. A logistic regression model was fitted to describe the trend in anaemia over time. RESULTS: At enrolment, the prevalence of any grade anaemia (Hb < 9.4 g/dl) was 61.8%, but fell during ARV therapy, reaching a nadir (7.4%) by 6 months post-partum. A total of 41 women (8%) developed severe anaemia (Hb < 7 g/dl) during follow-up; 2 (4.9%) were hospitalised for blood transfusion, whereas 3 (7.3%) were transfused while hospitalised (for delivery). The greatest proportion of severe anaemia events occurred around delivery (48.8%; n = 20). Anaemia (Hb ≥ 7 and < 9.4 g/dl) at enrolment was associated with severe anaemia at delivery (OR 5.87; 95% CI: 4.48, 7.68, P < 0.01). Few cases of severe anaemia coincided with clinical malaria (24.4%; n = 10) and helminth (7.3%; n = 3) infections. CONCLUSION: Resolution of anaemia among most participants during study follow-up was likely related to receipt of ARV therapy. Efforts should be geared towards addressing common causes of anaemia in HIV-infected pregnant women, prioritising initiation of ARV therapy and management of peripartum blood loss.

[Switch of methoxy-polyethylene-glycol-epoetin beta to darbepoetin alfa in 263 dialysis patients]. / Étude de la conversion du méthoxypolyéthylèneglycol-époétine bêta vers la darbépoétine alfa chez 263 patients hémodialysés.

In early 2012, due to national supply disruption, the methoxy-polyethylene glycol-epoetin beta (CERA) was no longer available and has been replaced by darbepoetin alfa (DA) in all dialysis patients. Official recommendations for the replacement of one by the other is missing or unclear. On this occasion, we wanted to examine how the shift from CERA to DA was done in terms of dose conversion factor and the other factors that could have influenced the dose of DA prescribed (hemoglobin, patient weight, dose of CERA). This retrospective multicenter open conducted in six dialysis centers in Alsace is the first large study (n=263) that evaluated the switch from CERA to DA in all chronic hemodialysis patients. We found that the instantaneous ratio of dose adjustment is close to 1 and that nephrologists are mainly based on the dose of CERA for determining the DA dose, before hemoglobin and weight. However, establishing a true dose-response ratio between the two molecules requires a long term prospective study.

High prevalence of anaemia among African migrants in Germany persists after exclusion of iron deficiency and erythrocyte polymorphisms.

OBJECTIVES: Haematological parameters differ between individuals of African and European ancestry. However, respective data of first-generation African migrants are virtually absent. We assessed these in Ghanaian migrants living in Berlin, compared them with reference data from Germany and Ghana, and estimated the role of iron deficiency (ID) and erythrocyte polymorphisms in anaemia. METHODS: A total of 576 Ghanaians (median age, 45 years) were analysed. Blood counts were performed, haemoglobinopathies and glucose-6-phosphate dehydrogenase (G6PD) deficiency were genotyped, and concentrations of ferritin and C-reactive protein were measured to define ID. RESULTS: Most individuals had resided in Germany for more than a decade (median, 18 years). By WHO definition, anaemia was present in 30.9% of females and 9.4% of males. Median haemoglobin (Hb) levels were lower than among Germans (women, -0.8 g/dl, men, -0.7 g/dl). However, applying reference values from Ghana, only 1.9% of the migrants were considered anaemic. Alpha-thalassaemia, Hb variants and G6PD deficiency were observed in 33.9%, 28.3% and 23.6%, respectively. ID was highly prevalent in women (32.0%; men, 3.9%). The population fraction of anaemia cases attributable to ID was 29.0% (alpha-thalassaemia, 13.6%; G6PD deficiency, 13.5%). Nevertheless, excluding ID, alpha-thalassaemia, G6PD deficiency and sickle cell disease, anaemia prevalence remained high (women, 18.4%; men, 6.5%), and was also high when applying uncensored thresholds proposed for African Americans (females, 19.3%; males, 7.8%). CONCLUSIONS: Iron deficiency and erythrocyte polymorphisms are common among first-generation Ghanaian migrants but explain only part of the increased prevalence of anaemia. Common Hb thresholds for the definition of anaemia may not be appropriate for this group.

Delayed cord clamping in South African neonates with expected low birthweight: a randomised controlled trial.

OBJECTIVE: To evaluate safety and haematological effects of delayed cord clamping (DCC) in infants with expected low birthweight born in a resource-poor setting. METHODS: Randomised controlled trial involving pregnant women in early labour ≥18 years with intrapartum symphysal-fundal height ≤32 cm. Mothers were randomised for either early cord clamping (ECC, <30 s) or DCC (2-3 min after birth). RESULTS: We included 104 vigorous infants born by vaginal delivery, of whom 39% had a birthweight <2500 g. Infant haemoglobin (Hb) levels 24 h after birth were significantly higher in the DCC group (18.0 g/dl vs. 16.8 g/dl, P = 0.006). Despite successful placental transfusion, hyperbilirubinemia and hyperviscosity were not observed. Two months after birth, there were no differences in Hb between groups (9.9 g/dl vs. 9.8 g/dl, P = 0.60), but the infants in the DCC group had better weight gain from baseline than those with ECC (2.2 kg vs. 1.9 kg, P = 0.058). CONCLUSIONS: In this South African cohort of newborns with a subnormal distribution of birthweight delayed cord clamping was a safe procedure. Two months after birth the effect of DCC on Hb was not detectable anymore. DCC should be promoted in every singleton delivery in a resource-poor setting irrespective of the birthweight.