Toxicology and Biodegradability of a Phthalate-Free and Bio-Based Novel Plasticizer.

Phthalate esters, mainly di-ethylhexylphthalate (DEHP), represent a class of chemicals primarily used as plasticizers for polyvinyl chloride in a wide range of domestic and industrial applications. These phthalate esters are low-toxicity environmental contaminants. To address these drawbacks, POLYSORB® ID 37, a blend of diesters obtained from esterification of isosorbide with plant-based fatty acids, was developed. The company can now offer PVC manufacturers a new product which competes with phthalates and other such chemicals. The market for plasticizers is very important, and ROQUETTE intends to provide a more sustainable and safer product. Isosorbide diester is bio-based (made from glucose and vegetable fatty acids). This plasticizer is registered in REACH regulation for high volumes (>1000 T/year). Risk assessment was obtained by conducting a wide range of biodegradability and toxicological protocols, using rodent models, according to established guidelines. Overall, all of the toxicological and biodegradability studies demonstrated that POLYSORB® ID 37 is nontoxic to mammalian life and is readily biodegradable.

The ALMANACH Project: Preliminary results and potentiality from Afghanistan.

INTRODUCTION: ALMANACH (ALgorithms for the MANagement of Acute CHildhood illnesses) is an electronic version of IMCI (Integrated Management of Childhood Illness) running on tablets. ALMANACH enhances its concept, it integrates well into health staff's daily consultation work and facilitates diagnosis and treatment. ALMANACH informs when to refer a child or to perform a rapid diagnostic test (RDT), recommends the right treatment dosage and synchronizes collected data real time with a Health Management Information System (DHIS2) for epidemiological evaluation and decision making. OBJECTIVES: Since May 2016, ALMANACH is under investigational deployment in three primary health care facilities in Afghanistan with the goal to improve the quality of care provided to children between 2 months and 5 years old. METHODS: IMCI's algorithms were updated in considering latest scientific publications, national guidelines, innovations in RDTs, the target population's epidemiological profile and the local resources available. Before the implementation of the project, a direct observation of 599 consultations was carried out to assess the daily performance at three selected health facilities in Kabul. RESULTS: The baseline survey showed that nutritional screening, vitamin A supplementation and deworming were not systematically performed: few patients were diagnosed for malnutrition (1.8%), received vitamin A (2.7%) or deworming (7.5%). Physical examination was appropriate only for 23.8% of the diagnoses of respiratory or gastrointestinal diseases, ear infection and sore throat. Respiratory rate was checked only in 33.5% of the children with fever and cough, dehydration status was assessed in only 16.5% of the diarrhoea cases. Forty-seven percent of patients received incorrect treatment. Sixty-four percent of the children, before the introduction of ALMANACH, received at least one antibiotic, although for 87.1% antibiotic therapy was unnecessary. The review of 8'047 paediatric consultations between May 2016 and September 2017 showed that with ALMANACH, malnutrition detection, deworming and Vitamin A supplementation increased respectively to 4.4%, 50.2% and 27.5%. Antibiotic prescription decreased to 21.83% and all children were examined and treated in compliance with the protocols. CONCLUSION: A survey will be conducted one year after the implementation to validate these initial promising results. If the efficacy of the approach is confirmed, ALMANACH could establish as a powerful innovation for primary health care.

Non-communicable diseases in humanitarian settings: ten essential questions.

Non-communicable diseases (NCDs) represent the primary cause of morbidity and mortality worldwide. Specific attention needs to be given in fragile and crisis-affected contexts, where health systems have even more difficulties in addressing and managing these diseases. Humanitarian actors intervening in crisis situations increasingly include NCD management in the services they support and provide. This review aims at presenting a series of questions that humanitarian agencies could consider when addressing NCDs in humanitarian crises. They include, among others, what conditions to address and for which target population, how to ensure continuity of care, which guidelines and medications to use, and what can be done beyond classical management of NCDs.Research and evidence are lacking on how to address care effectively for NCDs in emergencies. Therefore, advocacy is needed for NCD-oriented research so as to make interventions more effective and sustainable. No government or single agency can address NCDs in humanitarian crises alone. Strong leadership and partnerships between humanitarian actors, health providers, government bodies, research and academic institutions are required. Only a coordinated multi-disciplinary and multi-stakeholder approach will achieve the required impact for affected populations.

Effects of peritoneal dialysis on the vascular bed of peritoneal membrane.

The vascularization of the peritoneal membrane is a key factor in the effectiveness of peritoneal dialysis as a dialysis modality. Over the last years, our understanding of how the peritoneal vasculature reacts to instillation of peritoneal dialysate has substantially improved. The changes in the structure of the peritoneal function over time on peritoneal dialysis as found in functional tests has been confirmed in biopsy studies performed on patients. These show both neoangiogenesis and fibrosis as the underlying morphological changes contributing to these phenomena. A thorough understanding of the biological processes involved in these alterations will be the clue for improvement of the treatment and a key to develop strategies to avoid these deformations.

The role of hyperhomocysteinemia in nitric oxide (NO) and endothelium-derived hyperpolarizing factor (EDHF)-mediated vasodilatation.

Hyperhomocysteinemia (HHcy) is associated with impaired endothelial-dependent vasodilatation and increased risk of atherosclerosis and thrombosis. Here, we summarize some of our previous work on the effect of HHcy on pathways involved in endothelium-dependent vasodilatation, and present new data concerning the endothelium-derived hyperpolarizing factor (EDHF)-mediated vasodilatation. We showed that the 894 G>T single-nucleotide polymorphism in the human endothelial nitric oxide synthase gene (eNOS) increased the risk of recurrent venous thrombosis in individuals with elevated homocysteine levels, indicating that the pathophysiological mechanism in HHcy involves impaired NO-mediated vasodilatation. In addition, the EDHF-mediated vasodilatation of the renal artery was disturbed in diet-induced hyperhomocysteinemic rats. Interestingly, we demonstrated that pretreatment of rats with periodate-oxidized adenosine (Adox), which is an inhibitor of S-adenosylhomocysteine hydrolase, prevented the methionine-induced rise in plasma total Hcy (tHcy) levels but not the inhibition of the EDHF pathway. Furthermore, we demonstrated that S-adenosylhomocysteine (AdoHcy) and S-adenosylmethionine (AdoMet) levels were increased in the kidneys of diet-induced HHcy rats, resulting in a decreased AdoMet:AdoHcy ratio. In addition, we demonstrated that mRNA expression of Connexin 40, which is one of the structural subunits of gap-junctions, was down-regulated in endothelial cells of HHcy rats, and correlated with elevated AdoHcy levels in kidney of these rats. These finding suggest a key role for AdoHcy in relation to decreased Cx40 mRNA expression and impaired EDHF-mediated vasodilatation of HHcy rats.

Intravital videomicroscopy in peritoneal dialysis research

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Non anticoagulant effects of heparin: implications for animal models of peritoneal dialysis.

Heparin is a glycosaminoglycan with well-known anticoagulant activity. That property is used in animal models of peritoneal dialysis to maintain catheter patency and to prevent the development of peritoneal adhesions. However, heparin has a host of biologic actions beyond its role as an anticoagulant. Heparin modulates the activity of various inflammatory cells, affects the synthesis of extracellular matrix, has antiproliferative effects on several cell types, and influences neoangiogenesis. By virtue of those actions, intraperitoneally administered heparin may interfere with peritoneal membrane homeostasis. The potential side effects of heparin use in animal models of peritoneal dialysis should be recognized to permit correct interpretation of experimental studies conducted in those models.

[Skeletal and velar myoclonus with vision disorders. Efficacy of carbamazepine]. / Myoclonies squelettiques et du voile avec troubles visuels. Efficacité de la carbamazépine.

The authors report the case of a 71 year-old woman presenting right velopharyngo-laryngeal and skeletal rhythmic myoclonus, associated with visual and phasic disorders. They appeared four months after an infarct in the region of the left posterior cerebral artery. The ischemia was of temporo-occipital location, very probably extending to the region of the left red nucleus, thereby interrupting the dento-olivary pathway. Several drugs which are usually active in the treatment of myoclonus proved ineffective. But carbamazepine at a dose of 600 mg per day was effective from the third day and remained so after seven months. It would seem to act by inhibiting the occurrence of paroxystic discharges of an epileptic type in the olivary body disinhibited by the underlying lesion.

[Hemiballism caused by metastasis to Luys' body]. / Hémiballisme par métastase du corps de Luys.

A 66 year-old man suddenly developed a left-sided hemiballism. CT scan revealed 3 metastases, one of them in the area of the right subthalamic nucleus (corpus Luysii). A primary lung tumor was suspected. Haloperidol and tiapride were unsuccessful to control the hemiballism. The patient died 5 months later. Pathological examination confirmed the diagnosis. The pathophysiology of this case is discussed with regard to the pathological findings. Hemiballism secondary to a metastasis is rare, 9 cases have been reported during the past 65 years. Vascular lesions are the usual cause (75 per cent); on rare occasions degenerative disorders (14 per cent), destructive (tumors: 10 per cent or surgical lesions: 0,3-9 per cent) can also result in hemiballism.