Specific balance training included in an endurance-resistance exercise program improves postural balance in elderly patients undergoing haemodialysis.

PURPOSE: The purpose of this study was to evaluate the effects of 6 months of specific balance training included in endurance-resistance program on postural balance in haemodialysis (HD) patients. METHODS: Forty-nine male patients undergoing HD were randomly assigned to an intervention group (balance training included in an endurance-resistance training, n = 26) or a control group (resistance-endurance training only, n = 23). Postural control was assessed using six clinical tests; Timed Up and Go test, Tinetti Mobility Test, Berg Balance Scale, Unipodal Stance test, Mini-Balance Evaluation Systems Test and Activities Balance Confidence scale. RESULTS: All balance measures increased significantly after the period of rehabilitation training in the intervention group. Only the Timed Up and Go, Berg Balance Scale, Mini-Balance Evaluation Systems Test and Activities Balance Confidence scores were improved in the control group. The ranges of change in these tests were greater in the balance training group. CONCLUSIONS: In HD patients, specific balance training included in a usual endurance-resistance training program improves static and dynamic balance better than endurance-resistance training only. Implications for rehabilitation Rehabilitation using exercise in haemodialysis patients improved global mobility and functional abilities. Specific balance training included in usual endurance resistance training program could lead to improved static and dynamic balance.

Effects of listening to Holy Qur'an recitation and physical training on dialysis efficacy, functional capacity, and psychosocial outcomes in elderly patients undergoing haemodialysis.

The purpose of this study was to determine whether listening to Holy Qur'an recitation would augment the beneficial effects of physical exercise on physiological and psychological measures in elderly patients undergoing haemodialysis. Fifty-three male haemodialysis patients were randomly assigned to an intervention group (listening to Holy Qur'an recitation in combination with endurance-resistance training, n = 28) or a control group (endurance-resistance training only, n = 25). Functional capacity was assessed using the Timed Up and Go test (TUG) and the Six-Minute Walk Test (6MWT). Psychosocial outcomes were assessed using the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) and Hospital Anxiety and Depression Scale (HADS). Dialysis adequacy (Kt/V) was calculated for all patients. After intervention, a significant Group × Period interaction effect was observed for all measured parameters (p < 0.05), except for 6MWT performance (p > 0.05). All measured parameters were significantly improved over baseline in both groups, except for Kt/V in the control group (p > 0.05). Moreover, final measurements were significantly higher in the intervention group than in the control group for all measured parameters, except for 6MWT performance and the physical component summary of the SF-36 (p > 0.05). In conclusion, the present study showed that listening to a recitation of the Holy Qur'an in combination with interdialytic endurance-resistance training induced an improvement in physical condition and quality of life and a large reduction in anxiety among patients undergoing haemodialysis.

The Effect of Interdialytic Combined Resistance and Aerobic Exercise Training on Health Related Outcomes in Chronic Hemodialysis Patients: The Tunisian Randomized Controlled Study.

Background: Tunisia has the highest prevalence of hemodialysis patients compared to the other countries in North Africa. Dialysis centers rarely offer an exercise program to prevent physiological and psychological dialysis therapy-related alterations in chronic hemodialysis patients. Aim: To examine the effect of combined endurance-resistance training program on physiological and psychological outcomes in patients undergoing hemodialysis. Methods: We designed a single blinded, randomized, controlled study for a period of 4 months. Patients were randomized to intervention group or control group. Intervention group patients received 4 training sessions per week, held on non-hemodialysis days for a period of 4 months, whereas control group patients continued their regular lifestyle practice without direct intervention from the personnel of this investigation. Patients were evaluated at baseline (initial assessment) and after the four-month study period (final assessment) by the same investigator blinded to treatment group assignment using physical, physiological, and psychological measurements. Results: Compared with control group, intervention group showed significant improvement in physical performance during the sit-to-stand-to-sit tests (STS-10: -16.2%, ES = -1.65; STS-60: +23.43%, ES = 1.18), handgrip force task (+23.54%, ES = 1.16), timed up and go test (-13.86%, ES = -1.13), and 6-min walk test (+15.94%, ES = 2.09). Likewise, mini nutritional assessment long form scores after intervention period were significantly higher in the intervention group compared to the control group (ES = 1.43). Physical and mental component scores of SF-36 questionnaire increased significantly in the intervention group (ES = 1.10 and ES = 2.06, respectively), whereas hospital anxiety and depression scale scores decreased significantly (ES = -1.65 and ES = -2.72, respectively). Regarding biological parameters, intervention group displayed improvement in systolic and diastolic blood pressures (ES = -2.77 and ES = -0.87, respectively), HDL-cholesterol, LDL-cholesterol, and triglycerides systematic levels (ES = 1.15, ES = -0.98, and ES = -1.01, respectively); however no significant effect of intervention period was observed on C-reactive protein, hemoglobin, albumin, and total cholesterol levels (P > 0.05). Conclusion: The current study showed that combined endurance-resistance training program had a beneficial effect on physical capacity and quality of life in chronic hemodialysis patients.

Association of POL1, MALT1, MC4R, PHLPP and DSEL single nucleotide polymorphisms in chromosome 18q region with type 2 diabetes in Tunisians.

Previous studies and replication analyses have linked chromosome 18q21.1-23 with type 2 diabetes (T2DM) and its complications, including diabetic nephropathy (DN). Here we investigated the association of POL1-nearby variant rs488846, MALT1-nearby variant rs2874116, MC4R-nearby variant rs1942872, PHLPP rs9958800 and DSEL-nearby variant rs9966483 single nucleotide polymorphisms (SNPs) in the 18q region, previously linked with DN in African-Americans, with T2DM in (North African) Tunisian subjects, followed by their association with DN, which was performed subsequent to the analysis of the association with T2DM. Study subjects comprised 900 T2DM cases and 748 normoglycemic control, and genotyping was carried out by PCR-RFLP analysis. Of the 5 SNPs analyzed, POL1-nearby variant rs488846 [P=0.044], and MC4R-nearby variant rs1942872 [P=0.012] were associated with moderate risk of T2DM. However, there was a lack of consistency in the association of the 5 tested SNPs with DN. As such, it appears that the three chromosome 18q region variants appear to play a role in T2DM pathogenesis, but not with DN in North African Tunisian Arabs.

Cytomegalovirus ischemic colitis and transverse myelitis in a renal transplant recipient.

We report a rare case of cytomegalovirus (CMV)-associated ischemic colitis and transverse myelitis (TM) occurring precociously after renal transplantation. A 57-year-old male was transplanted with a cadaveric kidney on 5 June 2009. The patient was CMV seropositive and the donor was seronegative. Transplantation was followed shortly by TM, which resulted in paraplegia. The results of magnetic resonance imaging of the spinal cord showed abnormalities. Twenty days after transplantation, he developed abdominal pain with melena and was diagnosed as having CMV-associated ischemic colitis confirmed by colonoscopy and biopsy. Serological data and identification of the viral genome by polymerase chain reaction were confirmatory for CMV. Treatment consisted of intravenous ganciclovir, followed by polyvalent immunoglobulin. The outcome was favorable. Symptomatic CMV infection is relatively common among the renal transplant population. Early colonoscopy is beneficial for making a quick diagnosis and therefore helps to institute a prompt management of CMV colitis. Myelitis is less common in transplant recipients and diagnosis, therefore, was more difficult.

Deafness and blindness in a renal transplant recipient with cryptococcal meningitis.

Infections are a major determinant of outcome in kidney transplantation. Opportunistic pathogens are common in kidney recipients and several organs can be affected. Central nervous system infection in transplant recipients is a medical emergency. There is limited information in the literature concerning post-transplantation cryptococcal infection. Deafness and blindness are not classic findings. We report a case of meningocerebral cryptococcosis complicated by deafness and blindness after kidney transplantation. Physicians need to consider the possibility of Cryptococcus neoformans when symptoms persist despite empiric antimicrobial therapy.

[Post-infectious glomerulonephritis: unusual etiology of postpartum acute renal failure]. / La glomérulonéphrite aiguë postinfectieuse : une cause inhabituelle d'insuffisance rénale aiguë du post-partum.

Severe pre-eclampsia and acute tubular necrosis due to hemorrhagic shock are the major causes of postpartum acute renal failure. Cortical necrosis and haemolytic uraemic syndrome are less frequently. Post-infectious glomerulonephritis as a cause of postpartum acute glomerular disease and renal failure has been rarely reported. We report a patient with postpartum acute glomerulonephritis who presented nephritic syndrome, the diagnosis of which was confirmed by renal biopsy.

Renin-angiotensin system polymorphisms in relation to hypertension status and obesity in a Tunisian population.

Essential hypertension (HTA) is the clinical expression of a disordered interaction between the genetic, physiological, and biochemical systems that under usual conditions maintain cardiovascular homeostasis. We studied the effects of the angiotensinogen M235T, angiotensin converting enzyme insertion/deletion (ACE I/D), and angiotensin II receptor 1 (AT1R) A1166C gene polymorphisms on the risk of HTA and to evaluate the relationship between these polymorphisms and obesity. We performed AGT, ACE and AGTR genotyping in 142 hypertensive patients and 191 control subjects using PCR-RFLP methods and PCR, respectively. The three polymorphisms were significantly associated with HTA. Individuals carrying the mutated TT of AGT, DD of ACE and CC of AT1R genotypes had an 1.67 (P = 0.032), 3.09 (P < 0.001) and 3.45 (P < 0.001)-fold increased risk of HTA. After adjustment for sex, smoking, diabetes, dyslipidemia, BMI, triglycerides and DD, TT and CC genotypes, BMI was independent risk factor of HTA (OR = 3.14; P < 0.001). An association of BMI with ACE gene polymorphism (P = 0.035), whereas no association with AGT and AT1R gene polymorphisms was obtained. The proportion of hypertensives is as high as 21.8 and 13.4% in the overweight and the obese DD group. The present study implies that the genotyping for the variants of RAS gene could in the future become an important part of the clinical process of risk identification for HTA.

[Surgical treatment of secondary hyperparathyroidism in patients with chronic renal failure]. / Traitement chirurgical de l'hyperparathyroïdie secondaire chez l'insuffisant rénal chronique.

OBJECTIVE: To identify the indications for subtotal parathyroidectomy (PTX) in secondary hyperparathyroidism (SHPT) and report postoperative, early and late complications of PTX. PATIENTS AND METHODS: We conducted a retrospective study of subjects with chronic renal failure operated in Tunisian hospitals who received subtotal PTX over 10 years from January 1997 to December 2007. We analyzed the clinical, biological and radiological parameters pre- and postoperatively. RESULTS: We included 70 patients with average age of 39.4 years, 55.7% men and 44.3% in dialysis for 7.75 ± 4.8 years before PTX. The initial nephropathy was interstitial in 50% of cases. No cases of diabetic nephropathy have been reported. The clinical signs were bone pain (88.6%), muscle pain (85.6%), pruritus (81.4%). Radiological signs of osteitis fibrosa were observed in the majority of patients mainly resorption of extremities (92.9%), thinning of cortical (85.7%) and osteosclerosis (87.1%). The most common indication of PTX (85.7% of cases) was the persistence of serum PTH of more than 800 pg/ml associated with hypercalcemia and/or hyperphosphatemia refractory to medical treatment. A subtotal PTX (3/4 or 7/8) was performed after ultrasound and scintigraphy in the majority of cases. The histology of the parathyroid glands showed diffuse hyperplasia (51.4%), nodular hyperplasia (45.7%) and adenoma (2.8%). The postoperative evolution was marked by an improvement of the clinical and radiological criteria in 80% of cases. A PTH level of less than 15 pg/ml was rarely observed (10% of cases), and a PTH level of more than 300 pg/ml concerned 13% of patients. We noted a low morbidity and mortality (no cases laryngeal paralysis or cervical hematoma). CONCLUSION: Surgical treatment of SHPT in Tunisia is very effective in our experience. The biological results are comparable to treatment with calcimimetics, not available in Tunisia and whose price is higher. An early treatment of disorders of bone and mineral metabolism should reduce the incidence of SHPT.

[Acute renal failure and fungus ball: A case report]. / Insuffisance rénale aiguë et obstacle mycélien : à propos d'un cas.

Fungus ball is rarely associated with acute renal failure (ARF). We report the case of a 65-year-old diabetic patient who has been admitted for a right kidney infection. Urinary exam showed a leucocyturia with a negative urine culture. Ultrasonography showed pelvicaliceal dilation. Nephroscopy revealed a fungal material in ureter. Culture of this material was positive for Candida tropicalis. After endoscopic and antifongic therapy, the serum creatinin decreased from 336 micromol/L to 150 micromol/L, indicating the good evolution of his renal function.

[Acute renal failure caused by renal lymphoma. A case report]. / Insuffisance rénale aiguë révélatrice d'un lymphome rénal. A propos d'un cas.

Acute renal failure, as the initial manifestation of lymphoma, has been reported only in a few cases. In this work, we report the case of a 28-year-old women admitted for acute renal failure. Her physical examination detected bilateral kidney enlargement. Laboratory evaluation revealed a serum creatinine value 218 micromol/l. A 24-hour urine collection analysis allowed the detection of 1g of protein. No red cells were found after urinanalysis. Renal ultrasound showed massively enlarged kidneys. Renal biopsy of the kidney and pathologic examination showed diffuse infiltration of the interstitium with lymphocytes and atypical cells positive for CD20 markers. A diagnosis of diffuse large B-cell type non-Hodgkin lymphoma was made. However, investigations revealed the presence of two others sites of lymphoma: gastric and ophthalmic. The patient's renal function and kidney size as well as the other lymphoma locations were normalized after the initiation of chemotherapy.

[Twin pregnancy after renal transplantation: first case reported in Tunisia]. / La grossesse gemellaire et la transplantation renale a propos d'une premiere observation Tunisienne.

Women with end-stage renal disease or on regular dialysis have low fertility. Renal transplantation restores not only normal renal and endocrine functions but also the reproductive function as well and this conception becomes possible. Pregnancy in transplanted women is at higher risk and necessitates a multidisciplinary follow up. We report the course and out come of two successful pregnancies, the second was the first case of twin pregnancy in Tunisia in a transplanted woman. Our patient is 35 years old had a chronic renal insufficiency, secondary to interstitial nephropathy. After six years of hemodialysis, she had received a renal graft from a living donor (his brother). A double drug immunosuppression was given (Prednisolone - Azathioprine). Two years later, she became pregnant and delivered a normal baby at term, and one year later she had a twin pregnancy that ended successfully and delivered by caesarian section a two babies with different sex. Pregnancy after renal transplantion must be considered as a risk factor for any subsquent pregnancy, and the risk nicreases in case of twin pregnancy.

Neuropsychiatric manifestations in a patient undergoing hemodialysis caused by treatment with oral acyclovir.

A 50-year-old woman who was being treated with hemodialysis was admitted for severe neuropsychiatric symptoms. She tested positive for antibody to hepatitis C virus. Her medical history revealed ophthalmic herpes zoster four days before her admission for which she was started on oral acyclovir (800 mg three times daily). Four days later, she became disoriented and agitated. She had visual hallucinations and myoclonus. She was diagnosed as having acyclovir toxicity and was instituted on vigorous dialysis. The serum acyclovir levels normalized and the patient became asymptomatic with three dialysis sessions. Our case further reinforces that the dose of acyclovir should be reduced in patients with renal failure and that dialysis is a good form of treatment for over dosage.

Secondary Amyloidosis, a Fatal Complication of Behcet's Disease: Three Case Reports.

Renal amyloidosis (RA) is known to be one of the many complications of Behcet's disease (BD) but its frequency has been often underestimated. In this paper, we report on three cases of RA in a series of 105 patients with BD. RA was clinically suspected in our patients by the presence of edema and/or hypotension. The nephrotic syndrome was present in all of them and one patient had associated renal failure. Renal biopsy showed amyloid deposits type AA in all cases.Our patients received Colchicine at doses of 1 mg per day but with disappointing results. Their prognosis was significantely impaired with our three patients dying at ten years, six months and four weeks after diagnosis of RA. We will try, through this clinical experience and based on the relevant literature to better understand this kind of morbid association.