Changes in cardiovascular disease risk factors over 30 years in Polynesians in the French Pacific Territory of Wallis Island.

BACKGROUND: Wallis Island is part of a French Territory in the South Pacific. In 1980 the prevalence of hypertension and type 2 diabetes mellitus (T2DM) was low, consistent with a subsistence economy. Considerable social and economic changes have occurred over the last 30 years. METHODS: Survey data from 1980 and 2009 were analysed by sex in 10-year age groups, and 25-64 years age-standardised to the 2008 Census. Means and prevalences were calculated for blood pressure, fasting plasma glucose, body mass index (BMI), blood cholesterol and triglycerides as risk factors contributing to cardiovascular disease. RESULTS: During 1980-2009 there were significant increases (p < 0.05) in age-standardised means and prevalences of blood pressure and hypertension, fasting plasma glucose and T2DM, BMI and obesity, blood cholesterol (men) and triglycerides; and non-significant increases in mean diastolic blood pressure and fasting plasma glucose in women. Mean cholesterol and the prevalence of elevated cholesterol declined in women. Hypertension prevalence increased from 12% to 43% in men and from 15% to 30% in women, with 42% of the increase in men and 33% of the increase in women statistically explained by increases in BMI. T2DM increased from 2.3% to 12.2% in men and from 4.0% to 15.8% in women, with 35% of the increase in men and 26% of the increase in women statistically explained by increases in BMI. CONCLUSIONS: Risk factors for cardiovascular disease have increased considerably in Wallis Island over the past 30 years, consistent with modernisation in way of life.

[Comparison of different techniques of hemodialysis vascular access flow evaluation: blood temperature monitoring thermodilution and doppler debimetry]. / Comparaison des mesures des débits d'abords vasculaires pour hémodialyse obtenues par méthode de thermodilution utilisant le module Blood Temperature Monitoring et par débimétrie doppler.

BACKGROUND: Access blood flow measurements are considered useful indicators for thrombosis prevention. It was the purpose of this study to compare measurements of access blood flow by two different techniques: duplex doppler and BTM thermodilution. METHODS: Patients included must be on chronic hemodialysis on arterioveinous vascular access. They must be in a unit fit with hemodialysis generator equipped with BTM tool. The measurements of access blood flow were made during the first hour of the hemodialysis session. A measurement with each technique was performed for each patient. RESULTS: Fifteen patients were included: seven men and eight women, average age 60.8 ± 9.2 years, average weight 76 ± 16 kg, duration on hemodialysis therapy 6.6 ± 6.1 years. Access blood flow was native fistula (14 patients) and a prothetic access (one patient). Average access blood flow was 1088 ± 586 mL/mn (doppler) and 1094 ± 570 mL/mn (BTM). Comparison of access flows obtained by the BTM and doppler techniques showed a strong linear relationship. The average time to perform a measure was six minutes for the doppler technique and five minutes for the BTM technique. No adverse effect was observed in our study. CONCLUSION: Our study shows a strong correlation between the two techniques (doppler and BTM) for the measurement of hemodialysis access blood flow. The BTM access blood flow measurement technique is fast, economic and made during the hemodialysis session by the nurse.

[Active WHO class IV lupus nephritis in a patient treated with etanercept for a psoriasic arthritis]. / Néphropathie lupique stade IV chez une patiente traitée par étanercept pour un rhumatisme psoriasique.

INTRODUCTION: Drug-induced lupus nephritis in patients treated with TNF α inhibitor is a rare adverse effect. Anti-TNF α therapies are commonly associated with the induction of auto-antibodies, whereas anti-TNF α-induced lupus is rare, most frequently involving arthritis and cutaneous lesions. However, several renal involvement has been reported. OBSERVATION: A 26-year old woman with a history of psoriasic arthritis treated with TNF α inhibitor (etanercept) presented with a biopsy-proved class IV lupus nephritis. The diagnosis of drug-induced lupus nephritis was probable and anti-TNF α therapy was discontinued. Standard lupus nephritis therapy was then started with prednisolone pulses and mycophenolate mofetil (MMF). Two weeks later, a septic shock following a leg cellulitis was caused by Pseudomonas aeruginosa and had a fatal evolution despite MMF withdrawal, adapted antibiotherapy and large wound excision. DISCUSSION: Our therapy was not different than for other class IV lupus nephritis. Our observation highlights two points: first the attributability to etanercept in lupic manifestations in our patient and second the therapeutic strategy in this particular case of drug-induced lupus. CONCLUSION: We reported a possible first case of IV lupus nephritis induced by anti-TNF α with a fatal evolution.