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Desjardins MP, Naccache L, Hébert A, Auger I, Teira P, Pelland-Marcotte MC. Very Early Diagnosis and Management of Congenital Erythropoietic Porphyria. Clin Pediatr (Phila) 2023; 62:399-403. [PMID: 36217751 PMCID: PMC10170564 DOI: 10.1177/00099228221128661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Congenital erythropoietic porphyria (CEP), a rare form of porphyria, is caused by a defect in the heme biosynthesis pathway of the enzyme uroporphyrinogen III synthase (UROS). Uroporphyrinogen III synthase deficiency leads to an accumulation of nonphysiological porphyrins in bone marrow, red blood cells, skin, bones, teeth, and spleen. Consequently, the exposure to sunlight causes severe photosensitivity, long-term intravascular hemolysis, and eventually, irreversible mutilating deformities. Several supportive therapies such as strict sun avoidance, physical sunblocks, red blood cells transfusions, hydroxyurea, and splenectomy are commonly used in the management of CEP. Currently, the only available curative treatment of CEP is hematopoietic stem cell transplantation (HSCT). In this article, we present a young girl in which precocious genetic testing enabled early diagnosis and allowed curative treatment with HSCT for CEP at the age of 3 months of age, that is, the youngest reported case thus far.
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Affiliation(s)
- Marie-Pier Desjardins
- CHU de Québec, Centre Hospitalier de l’Université Laval, Department of Pediatrics, Université Laval, Québec City, QC, Canada
- Marie-Pier Desjardins, CHU de Québec, Centre Hospitalier de l’Université Laval, Department of Pediatrics, Université Laval, 2705 Boulevard Laurier, Quebec City, QC G1V 4G2, Canada.
| | - Lamia Naccache
- CHU de Québec, Centre Hospitalier de l’Université Laval, Department of Pediatrics, Université Laval, Québec City, QC, Canada
| | - Audrey Hébert
- CHU de Québec, Centre Hospitalier de l’Université Laval, Department of Pediatrics, Université Laval, Québec City, QC, Canada
| | - Isabelle Auger
- CHU de Québec, Centre Hospitalier de l’Université Laval, Division of Dermatology, Department of Medicine, Université Laval, Québec City, QC, Canada
| | - Pierre Teira
- CHU Sainte-Justine, Division of Hematology/Oncology, Department of Pediatrics, University of Montréal, Montréal, QC, Canada
| | - Marie-Claude Pelland-Marcotte
- CHU de Québec, Centre Hospitalier de l’Université Laval, Department of Pediatrics, Université Laval, Québec City, QC, Canada
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Wang YP, Sidibé A, Fortier C, Desjardins MP, Ung RV, Kremer R, Agharazii M, Mac-Way F. Wnt/β-catenin pathway inhibitors, bone metabolism and vascular health in kidney transplant patients. J Nephrol 2023; 36:969-978. [PMID: 36715822 DOI: 10.1007/s40620-022-01563-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/25/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Sclerostin, dickkopf-related protein 1 (DKK1), fibroblast growth factor-23 (FGF23) and α-klotho have been shown to play an important role in bone and vascular disease of chronic kidney disease. We aimed to evaluate the evolution of these bone markers in newly kidney transplanted patients, and whether they are associated with bone metabolism and vascular stiffness. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS This is a longitudinal single-center observational cohort study. Circulating levels of Wnt/β-catenin pathway inhibitors (sclerostin, DKK1, FGF23 and α-klotho), arterial stiffness (carotid-femoral pulse-wave velocity (PWV), carotid-radial PWV, PWV ratio, augmented index) and bone parameters were assessed before (M0), and at 3 (M3) and 6 months (M6) after transplantation. Generalized estimating equations were conducted for comparative analyses between the three time points. We used a marginal structural model for repeated measures for the impact of changes in bone markers on the evolution of arterial stiffness. Multivariate linear regression analyses were performed for the associations between Wnt/β-catenin pathway inhibitors and mineral metabolism parameters. RESULTS We included 79 patients (70% male; median age of 53 (44-60) years old). The levels of sclerostin (2.06 ± 1.18 ng/mL at M0 to 0.88 ± 0.29 ng/mL at M6, p ≤ 0.001), DKK1 (364.0 ± 266.7 pg/mL at M0 to 246.7 ± 149.1 pg/mL at M6, p ≤ 0.001), FGF23 (5595 ± 9603 RU/mL at M0 to 137 ± 215 RU/mL at M6, p ≤ 0.001) and α-klotho (457.6 ± 148.6 pg/mL at M0 to 109.8 ± 120.7 pg/mL at M6, p < 0.05) decreased significantly after kidney transplant. Sclerostin and FGF23 were positively associated with carotid-femoral (standardized β = 0.432, p = 0.037 and standardized β = 0.592, p = 0.005) and carotid-radial PWV (standardized β = 0.259, p = 0.029 and standardized β = 0.242, p = 0.006) throughout the 6 months of follow-up. The nature of the associations between bone markers and bone metabolism parameters varies after kidney transplant. CONCLUSIONS The circulating levels of Wnt/β-catenin pathway inhibitors and α-klotho significantly decrease after kidney transplantation, while sclerostin and FGF23 levels might be associated with improvement of vascular stiffness and blood pressure.
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Affiliation(s)
- Yue-Pei Wang
- Endocrinology and Nephrology Unit, Faculty and Department of Medicine, CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Université Laval, 10 McMahon, Quebec, QC, G1R 2J6, Canada
| | - Aboubacar Sidibé
- Endocrinology and Nephrology Unit, Faculty and Department of Medicine, CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Université Laval, 10 McMahon, Quebec, QC, G1R 2J6, Canada
| | - Catherine Fortier
- Endocrinology and Nephrology Unit, Faculty and Department of Medicine, CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Université Laval, 10 McMahon, Quebec, QC, G1R 2J6, Canada
| | - Marie-Pier Desjardins
- Endocrinology and Nephrology Unit, Faculty and Department of Medicine, CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Université Laval, 10 McMahon, Quebec, QC, G1R 2J6, Canada
| | - Roth-Visal Ung
- Endocrinology and Nephrology Unit, Faculty and Department of Medicine, CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Université Laval, 10 McMahon, Quebec, QC, G1R 2J6, Canada
| | - Richard Kremer
- Faculty and Department of Medicine, McGill University Health Center, Royal Victoria Hospital, McGill University, Montréal, Canada
| | - Mohsen Agharazii
- Endocrinology and Nephrology Unit, Faculty and Department of Medicine, CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Université Laval, 10 McMahon, Quebec, QC, G1R 2J6, Canada
| | - Fabrice Mac-Way
- Endocrinology and Nephrology Unit, Faculty and Department of Medicine, CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Université Laval, 10 McMahon, Quebec, QC, G1R 2J6, Canada.
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Rached-d'Astous S, Finkelstein Y, Bailey B, Marquis C, Lebel D, Desjardins MP, Trottier ED. Intranasal ketamine for procedural sedation in children: An open-label multicenter clinical trial. Am J Emerg Med 2023; 67:10-16. [PMID: 36774905 DOI: 10.1016/j.ajem.2023.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION There are limited options for pain and distress management in children undergoing minor procedures, without the burden of an intravenous line insertion. Prior to this study, we conducted a dose-escalation study and identified 6 mg/kg as a potentially optimal initial dose of intranasal ketamine. OBJECTIVE To assess the efficacy and safety of intranasal ketamine at a dose of 6 mg/kg for procedural sedation to repair lacerations with sutures in children in the emergency department. METHODS We conducted a single-arm, open-label multicenter clinical trial for intranasal ketamine for laceration repair with sutures in children aged 1 to 12 years. A convenience sample of 30 patients received 6 mg/kg of intranasal ketamine for their procedural sedation. The primary outcome was the proportion (95% CI) of patients who achieved an effective procedural sedation. RESULTS We recruited 30 patients from April 2018 to December 2019 in two pediatric emergency departments in Canada. Lacerations repaired were mostly facial in 21(70%) patients and longer than 2 cm in 20 (67%) patients. Sedation was effective in 18/30 (60% [95% CI 45, 80]) children and was suboptimal in 5 (17%) patients but procedure was completed in them with minimal difficulties. Sedation was poor in the remaining 7 (23%) patients, with 3 (10%) of them required additional sedative agents. No serious adverse events were reported. CONCLUSIONS Using a single dose of 6 mg/kg of intranasal Ketamine for laceration repair led to successful sedation in 60% of patients according to our a priori definition. An additional 17% of patients were considered suboptimal, but their procedure was still completed with minimal difficulty. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (NCT03053947).
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Affiliation(s)
- Soha Rached-d'Astous
- Pediatric Emergency Department, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, 3175 Chem. de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada.
| | - Yaron Finkelstein
- Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Benoit Bailey
- Pediatric Emergency Department, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, 3175 Chem. de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Christopher Marquis
- Pharmacy department, CHU Sainte Justine, 3175 Chem. de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Denis Lebel
- Pharmacy department, CHU Sainte Justine, 3175 Chem. de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Marie-Pier Desjardins
- Pediatric Emergency Department, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, 3175 Chem. de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Evelyne D Trottier
- Pediatric Emergency Department, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, 3175 Chem. de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
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Weill O, Labrosse M, Levy A, Desjardins MP, Trottier ED, Gravel J. 69 Triage Administration of Ondansetron for Gastroenteritis in children; a randomized controlled trial. Paediatr Child Health 2022. [PMCID: PMC9620576 DOI: 10.1093/pch/pxac100.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Acute gastroenteritis is an important reason for emergency department (ED) consultation in children. Ondansetron is reported to be effective in reducing vomiting in children with gastroenteritis, leading to less intravenous rehydration and hospital admission. Objectives The aim of this study was to assess the effectiveness of triage nurse-initiated administration of ondansetron for children with suspected gastroenteritis in the paediatric ED to reduce the number of patients requiring observation following the first physician assessment. Design/Methods This was a randomized controlled trial performed in a tertiary care paediatric ED. All children 6 months to 17 years old who presented to the ED with at least four episodes of non-billous, non-bloody vomiting in the previous 24 hours and the last vomiting occurring within the previous 2h were eligible. The intervention consisted of administration of a liquid formulation of an adapted to weight dose of ondansetron at triage compared to a color- and taste-matched placebo. The primary outcome was the number of patients requiring observation after the first physician’s evaluation. Secondary outcomes were the number of episodes of vomiting after receiving the intervention, length of stay in the ED, comfort, and the proportion of children who returned for a medical visit within 48 hours. A sample size of 248 participants was initially identified to have a power of 90% to find a 20% difference in the proportion of children needing observation following physician evaluation. Results Because of multiple external factors, including the COVID-19 pandemic, recruitment was stopped before the expected sample size was reached. A total of 91 patients were included and randomized to receive ondansetron (n= 44) or a placebo (n=47) just after triage. The baseline characteristics of the participants was similar between the two groups. A total of 40 (45%) participants were discharged immediately after the first evaluation by the treating physician. This was similar for both groups 44% vs. 45%; (95% CI for the difference -20 to 19%). There was no difference between the two groups for the total length of stay (median 232 vs. 227 minutes; p= 0.677) and for the length of stay after being seen by the physician (72 vs. 68 minutes; p=0.821). There was no statistical difference between the two groups in the number of vomiting episodes (difference of 15%; 95% CI -2, 31), and proportion of participants needing a rescue medication (difference: 19%; 95%CI:-0.6 to 36%) or an intravenous rehydration (difference: 8; 95%CI:-6, 22). Conclusion This study failed to demonstrate any benefit in using ondansetron at triage for children with presumed gastroenteritis. ![]()
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Champagne PA, Bourassa M, Desjardins MP, Cloutier S, Demers C, Singbo NU, Néron H, Pelland-Marcotte MC. Post-procedural bleeding rate and haemostatic treatment use for dental procedures before and after the implementation of a standardized protocol for people with inherited bleeding disorders. Haemophilia 2022; 28:806-813. [PMID: 35751905 DOI: 10.1111/hae.14609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/27/2022] [Accepted: 06/08/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Persons with inherited bleeding disorders are at a substantial risk of bleeding following dental procedures. AIM To compare the outcomes and use of haemostatic treatment pre- and post-implementation of a standardized protocol for dental procedures at a Hemophilia Treatment Centre. METHODS We conducted a retrospective cohort study of outpatient and inpatient dental procedures and maxillofacial surgeries sustained by people with bleeding disorders treated at a comprehensive Hemophilia Treatment Centre (2013-2020), comparing patients' outcomes before and after the introduction of the protocol in 2018. The protocol, built using a multidisciplinary approach, suggested haemostatic treatment based on the invasiveness of the dental procedure and the proposed anaesthesia. Our primary outcome was the rate of procedural bleeding leading to medical or dental reintervention within 10 days. Secondary outcomes included the use of systemic haemostatic treatment and treatment-related adverse effects. RESULTS Overall, 137 dental procedures in 95 patients (median age: 29 years; 78% males; 74% haemophilia, 14% von Willebrand disease, 12% other disorders) were included. Seventeen procedural bleedings were reported (12.4%). Procedural bleeding occurred in 14.8% and 8.9% of patients in the control and intervention groups (p = .304). No major bleeding occurred. Tranexamic acid was used more consistently after protocol implementation (72.8% vs. 89.3%, p = .019), while factor concentrates use decreased (65.4% vs. 44.6%, p = .016), and desmopressin use remained constant (46.4% vs. 32.1%, p = .100). No treatment-related adverse effects were reported. CONCLUSION The use of a standardized protocol increased the use of tranexamic acid, with a nonstatistically significant reduction in procedural bleeding rate.
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Affiliation(s)
| | - Michelle Bourassa
- Centre d'hémophilie de l'Est du Québec, Quebec City, Canada.,Medicine and Dental Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Canada
| | - Marie-Pier Desjardins
- Department of Pediatrics, CHU de Québec - Centre Mère-Enfant Soleil, Quebec City, Quebec, Canada
| | - Stéphanie Cloutier
- Centre d'hémophilie de l'Est du Québec, Quebec City, Canada.,Department of Hematology, CHU de Québec, Quebec City, Quebec, Canada
| | - Christine Demers
- Centre d'hémophilie de l'Est du Québec, Quebec City, Canada.,Department of Hematology, CHU de Québec, Quebec City, Quebec, Canada
| | - Narcisse Ulrich Singbo
- Recherche Clinique et Évaluative, CHU de Québec Research Center, Quebec City, Quebec, Canada
| | - Hélène Néron
- Centre d'hémophilie de l'Est du Québec, Quebec City, Canada
| | - Marie-Claude Pelland-Marcotte
- Centre d'hémophilie de l'Est du Québec, Quebec City, Canada.,Division of Pediatric Hematology-Oncology, CHU de Québec - Centre Mère-Enfant Soleil, Quebec City, Quebec, Canada
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Desjardins MP, Hébert A, Pelland-Marcotte MC. 74 Central venous line-related thrombosis in neonates: A population-based study. Paediatr Child Health 2021. [DOI: 10.1093/pch/pxab061.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Primary Subject area
Neonatal-Perinatal Medicine
Background
The incidence of central venous line (CVL)-related thromboembolism (TE) in neonates is rising dramatically. The mainstay of treatment in neonatal thrombosis is anticoagulant therapy. However, management of neonatal CVL-related TE is particularly complex, as the higher risk of systemic and intracranial bleeding, especially in premature babies, must be balanced with the thrombotic risks, including death, or morbidity such as organ dysfunction, post-thrombotic syndrome, and neurodevelopmental sequelae. There is a paucity of evidence regarding the epidemiology of neonatal CVL-related thrombosis, to help clinicians identify neonates at high-risk of CVL-related thrombosis, as well as to tailor treatment based on the risks and benefits of anticoagulants in neonates.
Objectives
The objectives of this retrospective cohort study are: 1) to determine the main risk factors of CVL-related TE in neonates admitted to the neonatal intensive care unit (NICU); and 2) to compare the effectiveness and safety between different antithrombotic treatment modalities for neonatal CVL-related TE using the Canadian Neonatal Network (CNN) database and electronic medical chart review.
Design/Methods
Neonates ≤ 28 days of life admitted to the NICU for ≥ 24 hours requiring a CVL with TE confirmed by imaging were included in the study. The main effectiveness outcome is the resolution of TE, whereas the main safety outcome is the apparition of a major bleeding. In this study (n=39), we compared the effectiveness and safety outcomes according to antithrombotic treatment modalities (conservative vs. anticoagulation).
Results
The median gestational age is 35[26-38] weeks, and the mean birth weight is 2096±1110 g. CVL responsible for TE was umbilical venous catheter (28%), umbilical arterial catheter (46%), peripherally inserted central catheter (PICC line) (8%), and peripheral arterial catheter (18%). The anticoagulation therapy is more effective to achieve a partial and complete resolution of TE than the conservative treatment after a mean follow-up of 7 weeks (p=0.02). However, there were no differences according to antithrombotic treatment group regarding safety outcome assessed by major bleedings (p=0.2).
Conclusion
Our results tend to suggest that anticoagulation therapy is more effective to achieve resolution of CVLs-related TE than conservative treatment without compromising the safety of neonates. However, a large multicentric study is required to evaluate the risks and benefits of anticoagulants in neonates.
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Rached-d’Astous S, Finkelstein Y, Bailey B, Marquis C, Lebel D, Desjardins MP, Trottier ED. 86 Intra-nasal ketamine for laceration repair in the Emergency Department: The DosINK studies. Paediatr Child Health 2020. [DOI: 10.1093/pch/pxaa068.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction/Background
Lacerations are common in children presenting to the emergency department (ED). Children can be uncooperative and in pain when repair with sutures is performed and may require procedural sedation. There is a growing interest in the intranasal (IN) route of administration for procedural sedation and pain control. In contrast to intravenous (IV) line placement, IN administration is relatively painless for the patient, is simple and rapid to administer by the healthcare provider and requires minimal training. Few studies have evaluated intranasal (IN) ketamine for procedural sedation in children, mostly for brief dental procedures, with doses between 3 to 9 mg/kg.
Objectives
We sought to determine the optimal IN ketamine dose for effective and safe procedural sedation for laceration repair with sutures in children aged 1 to 12 years presenting to the ED using a two-step (dosINK- 1 trial and dosINK-2 trial) dose-finding clinical trial design.
Design/Methods
We enrolled otherwise healthy children 1 to 12 years requiring PS for their laceration repair by sutures in the ED. DosINK-1 consisted in a single center 3 + 3 dose escalation trial design with an initial dose of 3 up to 9 mg/kg of IN ketamine. For each dose, 3 patients were enrolled. Escalation to the next dose was performed if sedation was unsuccessful without serious adverse event (SAE). This process was repeated until 6 consecutive patients reached adequate PS with a maximum of 1 SAE. The primary outcome was the optimal dose for adequate PS as per the PERC/PECARN consensus criteria.
We subsequently conducted DosINK-2, a multicenter single-arm clinical trial. We enrolled a convenience sample of 30 children who all received the identified dose of IN ketamine from DosINK-1. The primary outcome was the proportion (95% CI) of patients who achieved adequate PS. Secondary outcomes included adverse events and parent, patient and physician satisfaction.
Results
In DosINK-1, 12 patients were recruited from April 2017 to March 2018 in one pediatric ED. Median age was 2.6 (interquartile range [IQR] 1.9, 3.7) years, 10 (85%) had facial laceration, and in 8 (67%) the laceration was >2 cm long. Sedation was adequate in 1/3 patients at doses of 3 and 4 mg/kg and in 3/3 patients at doses of 5 and 6 mg/kg, all without SAE. The identified dose of IN ketamine was 6 mg/kg. Nausea and vomiting in 4/12 (33%) patients were the only reported side effects.
In DosINK-2, we recruited 30 patients from April 2018 to November 2019 in two pediatric EDs. The median age was 3.2 (IQR 1.9, 4.7) years; 21 (70%) had facial laceration, and in 20 (67%) the laceration was longer than 2 cm. Sedation was adequate in 18/30 (60% [95% CI 45, 80]) children, was suboptimal (procedure completed with minimal difficulties) in 6 (20%), was poor (struggle that interfered with procedure, competed with difficulty) in 3 (10%) and required additional sedative agents in 3 (10%) patients. Twenty-one (70%) physicians were willing to reuse IN ketamine at the same doses and 25 (83%) parents would agree to the same sedation in the future. Median time to return to baseline status was 58 min (IQR 33, 73). Two patients, including one who received supplemental IV ketamine, desaturated during the procedure and required oxygen by-mask and repositioning. After the procedure, 1(3%) patient had nausea, and 2(7%) vomited.
Conclusion
A single dose of 6 mg/kg of IN ketamine for PS during laceration repair by sutures in children in the ED was adequate in 60%(95% CI 45, 80). In an additional 20% PS was suboptimal, but procedures were completed with minimal difficulties only. IN ketamine, which saves painful IV insertion, was acceptable by most physicians and parents. An additional IN ketamine dose may further increase the proportion of adequate sedation, but its safety and efficacy should be examined.
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Fortier C, Côté G, Mac-Way F, Goupil R, Desbiens LC, Desjardins MP, Marquis K, Hametner B, Wassertheurer S, Schultz MG, Sharman JE, Agharazii M. Prognostic Value of Carotid and Radial Artery Reservoir-Wave Parameters in End-Stage Renal Disease. J Am Heart Assoc 2019; 8:e012314. [PMID: 31220992 PMCID: PMC6662378 DOI: 10.1161/jaha.119.012314] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Reservoir-wave approach is an alternative model of arterial hemodynamics based on the assumption that measured arterial pressure is composed of volume-related (reservoir pressure) and wave-related components (excess pressure). However, the clinical utility of reservoir-wave approach remains debatable. Methods and Results In a single-center cohort of 260 dialysis patients, we examined whether carotid and radial reservoir-wave parameters were associated with all-cause and cardiovascular mortality. Central pulse pressure and augmentation index at 75 beats per minute were determined by radial arterial tonometry through generalized transfer function. Carotid and radial reservoir-wave analysis were performed to determine reservoir pressure and excess pressure integral. After a median follow-up of 32 months, 171 (66%) deaths and 88 (34%) cardiovascular deaths occurred. In Cox regression analysis, carotid excess pressure integral was associated with a hazard ratio of 1.33 (95% CI , 1.14-1.54; P<0.001 per 1 SD) for all-cause and 1.45 (95% CI : 1.18-1.75; P<0.001 per 1 SD) for cardiovascular mortality. After adjustments for age, heart rate, sex, clinical characteristics and carotid-femoral pulse wave velocity, carotid excess pressure integral was consistently associated with increased risk of all-cause (hazard ratio per 1 SD, 1.30; 95% CI : 1.08-1.54; P=0.004) and cardiovascular mortality (hazard ratio per 1 SD, 1.31; 95% CI : 1.04-1.63; P=0.019). Conversely, there were no significant associations between radial reservoir-wave parameters, central pulse pressure, augmentation index at 75 beats per minute, pressure forward, pressure backward and reflection magnitude, and all-cause or cardiovascular mortality after adjustment for comorbidities. Conclusions These observations support the clinical value of reservoir-wave approach parameters of large central elastic vessels in end-stage renal disease.
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Affiliation(s)
- Catherine Fortier
- 1 CHU de Québec Research Center L'Hôtel-Dieu de Québec Hospital Québec Quebec Canada.,2 Division of Nephrology Faculty of Medicine Université Laval Québec Quebec Canada
| | - Gabrielle Côté
- 2 Division of Nephrology Faculty of Medicine Université Laval Québec Quebec Canada
| | - Fabrice Mac-Way
- 1 CHU de Québec Research Center L'Hôtel-Dieu de Québec Hospital Québec Quebec Canada.,2 Division of Nephrology Faculty of Medicine Université Laval Québec Quebec Canada
| | - Rémi Goupil
- 3 Hôpital du Sacré-Cœur de Montréal Montréal Quebec Canada
| | - Louis-Charles Desbiens
- 1 CHU de Québec Research Center L'Hôtel-Dieu de Québec Hospital Québec Quebec Canada.,2 Division of Nephrology Faculty of Medicine Université Laval Québec Quebec Canada
| | - Marie-Pier Desjardins
- 1 CHU de Québec Research Center L'Hôtel-Dieu de Québec Hospital Québec Quebec Canada.,2 Division of Nephrology Faculty of Medicine Université Laval Québec Quebec Canada
| | - Karine Marquis
- 1 CHU de Québec Research Center L'Hôtel-Dieu de Québec Hospital Québec Quebec Canada
| | - Bernhard Hametner
- 4 Center for Health & Bioresources AIT Austrian Institute of Technology Vienna Austria
| | | | - Martin G Schultz
- 5 Menzies Institute for Medical Research University of Tasmania Hobart Australia
| | - James E Sharman
- 5 Menzies Institute for Medical Research University of Tasmania Hobart Australia
| | - Mohsen Agharazii
- 1 CHU de Québec Research Center L'Hôtel-Dieu de Québec Hospital Québec Quebec Canada.,2 Division of Nephrology Faculty of Medicine Université Laval Québec Quebec Canada
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LaTour AT, Desjardins MP, Gravel J. 105 Evaluation of bedside sonography performed by emergency physicians to detect intussusception in children in the emergency department. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz066.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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LaTour AT, Desjardins MP, Gravel J. 106 Derivation and validation of a clinical decision rule to identify children at risk for intussusception. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz066.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sidibé A, Fortier C, Desjardins MP, Zomahoun HTV, Boutin A, Mac-Way F, De Serres S, Agharazii M. Reduction of Arterial Stiffness After Kidney Transplantation: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2017; 6:JAHA.117.007235. [PMID: 29269351 PMCID: PMC5779037 DOI: 10.1161/jaha.117.007235] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background End‐stage kidney disease is associated with increased arterial stiffness. Although correction of uremia by kidney transplantation (KTx) could improve arterial stiffness, results from clinical studies are unclear partly due to small sample sizes. Method and Results We conducted a systematic review and meta‐analysis of before‐after design studies performed in adult KTx patients with available measures of arterial stiffness parameters (pulse wave velocity [PWV], central pulse pressure [PP], and augmentation index) before and at any time post‐KTx. Mean difference of post‐ and pre‐KTx values of different outcomes were estimated using a random effect model with 95% confidence interval. To deal with repetition of measurement within a study, only 1 period of measurement was considered per study by analysis. Twelve studies were included in meta‐analysis, where a significant decrease of overall PWV by 1.20 m/s (95% CI 0.67‐1.73, I2=72%), central PWV by 1.20 m/s (95% CI 0.16‐2.25, I2=83%), peripheral PWV by 1.17 m/s (95% CI 0.17‐2.17, I2=79%), and brachial‐ankle PWV by 1.21 m/s (95% CI 0.66‐1.75, I2=0%) was observed. Central PP (reported in 4 studies) decreased by 4.75 mm Hg (95% CI 0.78–10.28, I2=50%). Augmentation index (reported in 7 studies) decreased by 10.5% (95% CI 6.9‐14.1, I2=64%). A meta‐regression analysis showed that the timing of assessment post‐KTx was the major source of the residual variance. Conclusions This meta‐analysis suggests a reduction of the overall arterial stiffness in patients with end‐stage kidney disease after KTx.
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Affiliation(s)
- Aboubacar Sidibé
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Canada.,Division of Nephrology, Faculty and Department of Medicine, Université Laval, Québec, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, Canada
| | - Catherine Fortier
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Canada.,Division of Nephrology, Faculty and Department of Medicine, Université Laval, Québec, Canada
| | - Marie-Pier Desjardins
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Canada.,Division of Nephrology, Faculty and Department of Medicine, Université Laval, Québec, Canada
| | - Hervé Tchala Vignon Zomahoun
- CHU de Québec Research Center, Université Laval Saint François d'Assise Hospital, Québec, Canada.,Quebec SPOR-SUPPORT Unit, Montreal, Québec, Canada
| | - Amélie Boutin
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, Canada
| | - Fabrice Mac-Way
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Canada.,Division of Nephrology, Faculty and Department of Medicine, Université Laval, Québec, Canada
| | - Sacha De Serres
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Canada.,Division of Nephrology, Faculty and Department of Medicine, Université Laval, Québec, Canada
| | - Mohsen Agharazii
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Canada .,Division of Nephrology, Faculty and Department of Medicine, Université Laval, Québec, Canada
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12
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Fortier C, Desjardins MP, Agharazii M. Aortic-Brachial Pulse Wave Velocity Ratio: A Measure of Arterial Stiffness Gradient Not Affected by Mean Arterial Pressure. Pulse (Basel) 2017; 5:117-124. [PMID: 29761086 DOI: 10.1159/000480092] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/04/2017] [Indexed: 11/19/2022] Open
Abstract
Background Aortic stiffness, measured by carotid-femoral pulse wave velocity (cf-PWV), is used for the prediction of cardiovascular risk. This mini-review describes the nonlinear relationship between cf-PWV and operational blood pressure, presents the proposed methods to adjust for this relationship, and discusses a potential place for aortic-brachial PWV ratio (a measure of arterial stiffness gradient) as a blood pressure-independent measure of vascular aging. Summary PWV is inherently dependent on the operational blood pressure. In cross-sectional studies, PWV adjustment for mean arterial pressure (MAP) is preferred, but still remains a nonoptimal approach, as the relationship between PWV and blood pressure is nonlinear and varies considerably among individuals due to heterogeneity in genetic background, vascular tone, and vascular remodeling. Extrapolations from the blood pressure-independent stiffness parameter β (β0) have led to the creation of stiffness index β, which can be used for local stiffness. A similar approach has been used for cardio-ankle PWV to generate a blood pressure-independent cardio-ankle vascular index (CAVI). It was recently demonstrated that stiffness index β and CAVI remain slightly blood pressure-dependent, and a more appropriate formula has been proposed to make the proper adjustments. On the other hand, the negative impact of aortic stiffness on clinical outcomes is thought to be mediated through attenuation or reversal of the arterial stiffness gradient, which can also be influenced by a reduction in peripheral medium-sized muscular arteries in conditions that predispose to accelerate vascular aging. Arterial stiffness gradient, assessed by aortic-brachial PWV ratio, is emerging to be at least as good as cf-PWV for risk prediction, but has the advantage of not being affected by operating MAP. Key Messages The negative impacts of aortic stiffness on clinical outcomes are proposed to be mediated through attenuation or reversal of arterial stiffness gradient. Aortic-brachial PWV ratio, a measure of arterial stiffness gradient, is independent of MAP.
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Affiliation(s)
- Catherine Fortier
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, and Division of Nephrology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Marie-Pier Desjardins
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, and Division of Nephrology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Mohsen Agharazii
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, and Division of Nephrology, Faculty of Medicine, Université Laval, Québec, QC, Canada
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13
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Desjardins MP, Sidibé A, Fortier C, Mac-Way F, Marquis K, De Serres S, Larivière R, Agharazii M. Association of interleukin-6 with aortic stiffness in end-stage renal disease. ACTA ACUST UNITED AC 2017; 12:5-13. [PMID: 29170076 DOI: 10.1016/j.jash.2017.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/14/2017] [Accepted: 09/26/2017] [Indexed: 11/30/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality in patients with chronic kidney disease (CKD). Aortic stiffness, a nontraditional risk factor, is associated with high rate of mortality in CKD. Using a CKD animal model with medial vascular calcification, we previously reported increased mRNA expression of interleukin-6 (IL-6), tumor necrosis factor (TNF), and interleukin-1β (IL-1β) in calcified aorta. The aim of the study was to investigate the association between IL-6, TNF, IL-1β, and aortic stiffness in end-stage renal disease patients. In a cross-sectional study, we enrolled 351 patients on dialysis. Aortic stiffness was assessed by carotid-femoral pulse wave velocity (cf-PWV), while central pulse pressure and augmentation index were assessed using generalized transfer function applied to the radial artery pressure wave form. Plasma IL-6, TNF, and IL-1β were measured by enzyme-linked immunosorbent assay. IL-6 was associated with cf-PWV adjusted for mean blood pressure (MBP) (standardized β = 0.270; P < .001). In a multivariate adjusted model for age, diabetes, hypertension, CVD, and MBP, IL-6 was still associated with cf-PWV (standardized β = 0.096; P = .026). The impact of age, diabetes, and CVD on cf-PWV was partially mediated by IL-6 in a mediation analysis. However, there were no associations between TNF, IL-1β, and aortic stiffness. While IL-6 was associated with augmentation index (standardized β = 0.224; P < .001) and central pulse pressure (standardized β = 0.162; P = .001) when adjusted for MBP and heart rate, this relationship was not significant after adjusting for potential confounders.This study suggests a potential role of IL-6 for CKD-related aortic stiffness.
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Affiliation(s)
- Marie-Pier Desjardins
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Division of Nephrology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Aboubacar Sidibé
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Division of Nephrology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Catherine Fortier
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Division of Nephrology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Fabrice Mac-Way
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Division of Nephrology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Karine Marquis
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Division of Nephrology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Sacha De Serres
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Division of Nephrology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Richard Larivière
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Division of Nephrology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Mohsen Agharazii
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Division of Nephrology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada.
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14
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Nicole M, Desjardins MP, Dery J, Gravel J. EVALUATION OF BEDSIDE SONOGRAPHY PERFORMED BY EMERGENCY PHYSICIANS TO DETECT ACUTE APPENDICITIS IN CHILDREN IN THE EMERGENCY DEPARTMENT. Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx086.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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Alix-Séguin L, Desjardins MP, Gaucher N, Lebel D, Gravel J, Gouin S. EFFECT ON PAIN OF AN ORAL SUCROSE SOLUTION VERSUS PLACEBO IN CHILDREN 1 TO 3 MONTHS OLD NEEDING NASOPHARYNGEAL ASPIRATION; A RANDOMIZED CONTROLLED TRIAL. Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx086.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Desjardins MP, Thorin-Trescases N, Sidibé A, Fortier C, De Serres SA, Larivière R, Thorin E, Agharazii M. Levels of Angiopoietin-Like-2 Are Positively Associated With Aortic Stiffness and Mortality After Kidney Transplantation. Am J Hypertens 2017; 30:409-416. [PMID: 28158589 DOI: 10.1093/ajh/hpw208] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 01/05/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Angiopoietin-like-2 (ANGPTL2) is a secreted proinflammatory glycoprotein that promotes endothelial dysfunction, atherosclerosis, and cardiovascular disease (CVD). Circulating ANGPTL2 is increased in chronic kidney disease (CKD), where the risk of CVD is amplified. The objectives of the present study were to (i) examine whether kidney transplantation (KTx) reduces ANGPTL2 levels, (ii) identify the determinants of ANGPTL2 after KTx, (iii) study the association of ANGPTL2 with aortic stiffness, and (iv) assess the impact of ANGPTL2 on mortality after KTx. METHODS In 75 patients, serum ANGPTL2 levels were measured at baseline and 3 months after KTx. Aortic stiffness was determined by carotid-femoral pulse wave velocity, glomerular filtration rate was estimated by CKD-EPI formula, and serum cytokines and endothlin-1 levels were determined 3 months after KTx. Survival analysis was performed using Kaplan-Meier and Cox regression after a median follow-up of 90 months. RESULTS After 3 months of KTx, ANGPTL2 levels decreased from 71 ng/ml (53-95) to 11 ng/ml (9-15) (P < 0.001). In multivariate analysis, age, lower renal function, and endothelin-1 were independently associated with higher post-KTx ANGPTL2 levels. ANGPTL2 was positively associated with aortic stiffness after KTx, even when adjusted for mean blood pressure (standardized β = 0.314; P = 0.008). During follow-up, 13 deaths occurred. The group of patients with higher post-KTx ANGPTL2 levels had a hazard ratio for mortality of 3.9 (95% confidence interval: 1.07-14.4; P = 0.039). CONCLUSION KTx significantly reduced serum ANGPTL2 levels. The positive association between post-KTx ANGPTL2, aortic stiffness and mortality, suggests that ANGPTL2 may play a biological role in CKD-related CVD.
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Affiliation(s)
- Marie-Pier Desjardins
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec hospital, Division of Nephrology, Department of medicine, Faculty of medicine, Université Laval, Québec City, Québec, Canada
| | | | - Aboubacar Sidibé
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec hospital, Division of Nephrology, Department of medicine, Faculty of medicine, Université Laval, Québec City, Québec, Canada
| | - Catherine Fortier
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec hospital, Division of Nephrology, Department of medicine, Faculty of medicine, Université Laval, Québec City, Québec, Canada
| | - Sacha A De Serres
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec hospital, Division of Nephrology, Department of medicine, Faculty of medicine, Université Laval, Québec City, Québec, Canada
| | - Richard Larivière
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec hospital, Division of Nephrology, Department of medicine, Faculty of medicine, Université Laval, Québec City, Québec, Canada
| | - Eric Thorin
- Université de Montréal, Montreal Heart Institute, Department of Surgery, Montréal, Québec, Canada
| | - Mohsen Agharazii
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec hospital, Division of Nephrology, Department of medicine, Faculty of medicine, Université Laval, Québec City, Québec, Canada
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17
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Fortier C, Sidibé A, Desjardins MP, Marquis K, De Serres SA, Mac-Way F, Agharazii M. Aortic–Brachial Pulse Wave Velocity Ratio. Hypertension 2017; 69:96-101. [DOI: 10.1161/hypertensionaha.116.08409] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 09/14/2016] [Accepted: 10/11/2016] [Indexed: 11/16/2022]
Abstract
Aortic stiffness, a cardiovascular risk factor, depends on the operating mean arterial pressure (MAP). The impact of aortic stiffness on cardiovascular outcomes is proposed to be mediated by the attenuation or the reversal of the arterial stiffness gradient. We hypothesized that arterial stiffness gradient is less influenced by changes in MAP. We aimed to study the relationship between MAP and aortic stiffness, brachial stiffness, and arterial stiffness gradient. In a cross-sectional study of a dialysis cohort (group A, n=304) and a cohort of hypertensive or kidney transplant recipient with an estimated glomerular filtration rate of >45 mL/min/1.73 m
2
(group B, n=114), we assessed aortic and brachial stiffness by measuring carotid–femoral and carotid–radial pulse wave velocities (PWV). We used aortic–brachial PWV ratio as a measure of arterial stiffness gradient. Although there was a positive relationship between MAP and carotid–femoral PWV (
R
2
=0.10 and 0.08;
P
<0.001 and
P
=0.003) and MAP and carotid–radial PWV (
R
2
=0.22 and 0.12;
P
<0.001 and
P
<0.001), there was no statistically or clinically significant relationship between MAP and aortic–brachial PWV ratio (
R
2
=0.0002 and 0.0001;
P
=0.8 and
P
=0.9) in group A and B, respectively. Dialysis status and increasing age increased the slope of the relationship between MAP and cf-PWV. However, we found no modifying factor (age, sex, dialysis status, diabetes mellitus, cardiovascular disease, and class of antihypertensive drugs) that could affect the lack of relationship between MAP and aortic–brachial PWV ratio. In conclusion, these results suggest that aortic–brachial PWV ratio could be considered as a blood pressure–independent measure of vascular aging.
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Affiliation(s)
- Catherine Fortier
- From the CHU de Québec Research Center, L’Hôtel-Dieu de Québec Hospital, Québec City, Canada (C.F., A.S., M.-P.D., K.M., S.A.D.S., F.M., M.A.); and Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Canada (C.F., A.S., M.-P.D., S.A.D.S., F.M., M.A.)
| | - Aboubacar Sidibé
- From the CHU de Québec Research Center, L’Hôtel-Dieu de Québec Hospital, Québec City, Canada (C.F., A.S., M.-P.D., K.M., S.A.D.S., F.M., M.A.); and Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Canada (C.F., A.S., M.-P.D., S.A.D.S., F.M., M.A.)
| | - Marie-Pier Desjardins
- From the CHU de Québec Research Center, L’Hôtel-Dieu de Québec Hospital, Québec City, Canada (C.F., A.S., M.-P.D., K.M., S.A.D.S., F.M., M.A.); and Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Canada (C.F., A.S., M.-P.D., S.A.D.S., F.M., M.A.)
| | - Karine Marquis
- From the CHU de Québec Research Center, L’Hôtel-Dieu de Québec Hospital, Québec City, Canada (C.F., A.S., M.-P.D., K.M., S.A.D.S., F.M., M.A.); and Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Canada (C.F., A.S., M.-P.D., S.A.D.S., F.M., M.A.)
| | - Sacha A. De Serres
- From the CHU de Québec Research Center, L’Hôtel-Dieu de Québec Hospital, Québec City, Canada (C.F., A.S., M.-P.D., K.M., S.A.D.S., F.M., M.A.); and Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Canada (C.F., A.S., M.-P.D., S.A.D.S., F.M., M.A.)
| | - Fabrice Mac-Way
- From the CHU de Québec Research Center, L’Hôtel-Dieu de Québec Hospital, Québec City, Canada (C.F., A.S., M.-P.D., K.M., S.A.D.S., F.M., M.A.); and Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Canada (C.F., A.S., M.-P.D., S.A.D.S., F.M., M.A.)
| | - Mohsen Agharazii
- From the CHU de Québec Research Center, L’Hôtel-Dieu de Québec Hospital, Québec City, Canada (C.F., A.S., M.-P.D., K.M., S.A.D.S., F.M., M.A.); and Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Canada (C.F., A.S., M.-P.D., S.A.D.S., F.M., M.A.)
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Agharazii M, Fortier C, Desjardins MP, Schultz M, Sharman J. 4.7 PARAMETERS OF THE RESERVOIR-WAVE APPROACH AND MORTALITY IN DIALYSIS POPULATION. Artery Res 2017. [DOI: 10.1016/j.artres.2017.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Desjardins MP, Sidibé A, Fortier C, Mac-Way F, De Serres S, Larivière R, Spronck B, Agharazii M. P108 IMPACT OF KIDNEY TRANSPLANTATION ON AORTIC STIFFNESS INDEX β0. Artery Res 2017. [DOI: 10.1016/j.artres.2017.10.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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20
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Desjardins MP, Gouin S, Gaucher N, Lebel D, Gravel J. A Randomized Double-Blind Trial Comparing the Effect on Pain of An Oral Sucrose Solution Versus Placebo in Children 1 To 3 Months Old Needing Urethral Catheterization. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e52a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND: Oral sweet solutions have been accepted as effective analgesics for procedures in the neonatal population. However, there have been a limited number of trials in older infants. These studies have conflicting results.
OBJECTIVES: To compare the efficacy of an oral sucrose solution versus placebo in reducing pain during urethral catheterization in infants 1 to 3 months old in the Emergency Department (ED).
DESIGN/METHODS: A randomized, double-blind clinical trial was conducted in a pediatric university-affiliated hospital ED. Infants, 1 to 3 months of age, were recruited and randomly allocated to receive 2 ml of 88% sucrose solution (SUC) or 2 ml of placebo solution (PLA) orally, 2 minutes before planned urethral catheterization. The primary outcome measure was the difference in pain scores as assessed by the Face, Legs, Activity, Cry and Consolability (FLACC) Pain Scale during at 1 min post procedure. Secondary outcome measures were the difference in pain scores using the Neonatal Infant Pain Scale (NIPS), crying time, variations in heart rate and adverse events.
RESULTS: Seventy-six participants were recruited and completed the study, 37 (group SUC) and 39 (group PLA) respectively. The mean difference in FLACC scores compared to baseline was 5.62±1.32 (SUC) vs. 6.21±1.15 (PLA) (p=.51) during catheterization and 2.70±1.21 (SUC) vs. 2.26±1.41 (PLA) at 1 min (p=.64) and 0.66±1.32 (SUC) vs. 1.26±1.00 (PLA) at 3 mins (p=.38). For the NIPS scores, it was 4.27±1.06 (SUC) vs. 4.69±0.92 (PLA) (p=.56) during procedure and 2.05±0.91 (SUC) vs. 1.97±1.19 (PLA) (p=.92) at 1 min and 0.49±0.89 (SUC) vs. 0.89±0.97 (PLA) (p=.54) at 3 mins. The difference in the mean crying time was not different between both groups: 99±34 secs (SUC) vs. 100±25 (PLA) (p=.99). No significant difference was found in participants’ heart rate variations during procedure 23±8 BPM (SUC) vs. 26±7 (PLA) (p=.60) and after 1 min 19±12 BPM (SUC) vs. 17±7 (PLA) (p=.76) and after 3 mins -1±12 BPM (SUC) vs. 3±6 (PLA) (p=.53). No adverse events were reported. The blinding was successful.
CONCLUSION: In infants 1 to 3 months of age undergoing urethral catheterization in the ED, administration of an oral sweet solution did not statistically decrease pain scores as measured by the FLACC and NIPS scales. Participants' heart rate variations and crying time were not significantly decreased when sucrose was provided.
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Desjardins MP, Sidibe A, Fortier C, De Serres S, Larivière R, Agharazii M. 11.4 RELATIONSHIP BETWEEN INFLAMMATORY CYTOKINES AND AORTIC STIFFNESS IN PATIENTS WITH CHRONIC KIDNEY DISEASE. Artery Res 2016. [DOI: 10.1016/j.artres.2016.10.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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22
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Sidibe A, Fortier C, Desjardins MP, Mac-Way F, De Serres S, Agharazii M. 5.3 REVERSIBILITY OF ARTERIAL STIFFNESS AFTER KIDNEY TRANSPLANTATION: SYSTEMATIC REVIEW AND META-ANALYSIS. Artery Res 2016. [DOI: 10.1016/j.artres.2016.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Desjardins MP, Thorin-Trescases N, Sidibe A, De Serres S, Larivière R, Thorin E, Agharazii M. 14.5 LEVELS OF ANGIOPOIETIN-LIKE-2 ARE POSITIVELY ASSOCIATED WITH AORTIC STIFFNESS AND MORTALITY AFTER KIDNEY TRANSPLANTATION. Artery Res 2016. [DOI: 10.1016/j.artres.2016.10.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Fortier C, Desjardins MP, Sidibe A, Allard M, Schultz MG, Sharman JE, Agharazii M. 11.6 THE AORTIC-TO-BRACHIAL STIFFNESS GRADIENT AND AORTIC RESERVOIR-EXCESS PRESSURE IN A DIALYSIS POPULATION. Artery Res 2016. [DOI: 10.1016/j.artres.2016.10.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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25
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Hoeffe J, Desjardins MP, Fischer J, Carrière B, Gravel J. 158: Present and Future of Emergency Point-of-Care Ultrasound in Pediatric Emergency Fellowship Programs in Canada. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Desjardins MP, Gouin S, Gaucher N. 152: A Randomized Double-Blind Trial on the Effect on Pain of an Oral Sucrose Solution in Children 1 to 3 Months Old Undergoing Simple Venipuncture. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e89a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fortier C, Desjardins MP, Turgeon D, Marquis K, Lebel M, Agharazii* M. P6.15 ATTENUATION OF ARTERIAL STIFFNESS GRADIENT WITH AGE AND ITS IMPACT ON CENTRAL PULSE WAVE PROFILE IN DIALYSIS PATIENTS. Artery Res 2015. [DOI: 10.1016/j.artres.2015.10.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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