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Background: IgG4-related kidney disease is a major manifestation of IgG4-related disease, a systemic fibroinflammatory disorder. However, the clinical and prognostic kidney-related factors in patients with IgG4-related kidney disease are insufficiently defined., Methods: We conducted an observational cohort study using data from 35 sites in two European countries. Clinical, biologic, imaging, and histopathologic data; treatment modalities; and outcomes were collected from medical records. Logistic regression was performed to identify the possible factors related to an eGFR ≤30 ml/min per 1.73 m 2 at the last follow-up. Cox proportional hazards model was performed to assess the factors associated with the risk of relapse., Results: We studied 101 adult patients with IgG4-related disease with a median follow-up of 24 (11-58) months. Of these, 87 (86%) patients were male, and the median age was 68 (57-76) years. Eighty-three (82%) patients had IgG4-related kidney disease confirmed by kidney biopsy, with all biopsies showing tubulointerstitial involvement and 16 showing glomerular lesions. Ninety (89%) patients were treated with corticosteroids, and 18 (18%) patients received rituximab as first-line therapy. At the last follow-up, the eGFR was below 30 ml/min per 1.73 m 2 in 32% of patients; 34 (34%) patients experienced a relapse, while 12 (13%) patients had died. By Cox survival analysis, the number of organs involved (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.01 to 1.55) and low C3 and C4 concentrations (HR, 2.31; 95% CI, 1.10 to 4.85) were independently associated with a higher risk of relapse, whereas first-line therapy with rituximab was protective (HR, 0.22; 95% CI, 0.06 to 0.78). At their last follow-up, 19 (19%) patients had an eGFR ≤30 ml/min per 1.73 m 2 . Age (odd ratio [OR], 1.11; 95% CI, 1.03 to 1.20), peak serum creatinine (OR, 2.74; 95% CI, 1.71 to 5.47), and serum IgG4 level ≥5 g/L (OR, 4.46; 95% CI, 1.23 to 19.40) were independently predictive for severe CKD., Conclusions: IgG4-related kidney disease predominantly affected middle-aged men and manifested as tubulointerstitial nephritis with potential glomerular involvement. Complement consumption and the number of organs involved were associated with a higher relapse rate, whereas first-line therapy with rituximab was associated with lower relapse rate. Patients with high serum IgG4 concentrations (≥5 g/L) had more severe kidney disease., (Copyright © 2023 by the American Society of Nephrology.)

Pyrazinamide (PZA) is a key antibiotic in current anti-tuberculosis regimens. Although the WHO has stressed the urgent need to obtain data on PZA resistance, in high tuberculosis burden countries, little is known about the level of PZA resistance, the genetic basis of such resistance or its link with Mycobacterium tuberculosis families. In this context, this study assessed PZA resistance through the molecular analysis of 260 Vietnamese M. tuberculosis isolates. First-line drug susceptibility testing, pncA gene sequencing, spoligotyping and mycobacterial interspersed repetitive units-variable number of tandem repeats (MIRU-VNTR) typing were performed. Overall, the pncA mutation frequency was 38.1% (99 out of 260 isolates) but was higher than 72% (89 out of 123 isolates) in multidrug and quadruple-drug resistant isolates. Many different pncA mutations (71 types) were detected, of which 55 have been previously described and 50 were linked to PZA resistance. Among the 16 novel mutations, 14 are likely to be linked to PZA resistance because of their mutation types or codon positions. Genotype analysis revealed that PZA resistance can emerge in any M. tuberculosis cluster or family, although the mutation frequency was the highest in Beijing family isolates (47.7%, 62 out of 130 isolates). These data highlight the high rate of PZA resistance-associated mutations in M. tuberculosis clinical isolates in Vietnam and bring into question the use of PZA for current and future treatment regimens of multidrug-resistant tuberculosis without PZA resistance testing.

Street-food vending has been increasing in many developing countries and particularly in Madagascar since 2000. Gastroenteric diseases cause 37% of all deaths each year, and 50% of children <5 years are infected with intestinal pathogens. However, there has been little information regarding the incidence of street-food-related diseases, or foodborne pathogens in pork, which is the most commonly eaten meat, along with chicken. Thus, the aim of this study was to investigate the safety of traditional ready-to-eat street-vended pork dishes and to assess the association of restaurant characteristics and cooking practices with Salmonella and Campylobacter contamination of these meals. Sixty street-restaurants were studied from March 2012 to August 2012 in Antananarivo. A questionnaire was submitted to the managers, and samples of ready-to-eat pork dishes were bought. Salmonella spp. were isolated in 10% of the 60 street-restaurants studied and in 5% samples of pork dishes. The most prevalent serovars isolated were Salmonella Typhimurium (44%) and Senftenberg (33%). Campylobacter was not detected. Only 4 of the 43 variables tested in the screening analysis were significantly associated with Salmonella spp. contamination of the street-restaurants. The risk for a restaurant to be Salmonella positive decreased when there were specific premises for the restaurant and when the staff was wearing specific clothes when working. Conversely, that risk increased when the temperature of ready-to-eat pork was <52 °C and when tablecloths were used in the restaurant.

Cases of dysgeusia or ageusia have been reported in patients treated with angiotensin II receptor antagonist such as losartan (5 cases), valsartan (1 case), eprosartan (1 case). This is the first case-report of ageusia following candesartan. A 46-year-old-male patient, with a medical history of renal chronic reject allograft disease, started candesartan 4 mg once daily to treat high blood pressure. Six months later, a progressive ageusia occurred with a burning mouth syndrome. He also developed aphthous ulcers of the mouth, stomatitis and perleche, which led him to lose 8 kilos within 13 months. Thirteen months after the beginning of the treatment candesartan was stopped. The symptoms and lesions required 2 to 3 weeks to disappear. Subsequently, appetite was found again as well as the sense of taste. The temporal sequence of events suggests a causal relationship between ageusia and candesartan.

The authors report one case of septicemia following the infection of a remaining endocardial electrode lead. From this observation and the literature's data, they are thinking that it is essential to remove the entire pacemaker system (electrode lead and generator) to cure this complication. They remind the different technics used to remove the endocardial leads.

The authors make a bibliographical review of methods for studying the microbiological contamination of closed atmosphere. In a first part, they study the origins of bacterial emission (emissions from nose and pharynx, aerosolization by hospital hands manipulations, skin's emissions). In a second part, the study concern the measure of atmospheric contamination. The authors insist on the correlation may be existed between the counting of all dimensions particles and the bacteria's presence in air. They analyse in details the biological methods of measure (sedimentation, centrifugation, filtration impact) and suggest a room classification according to theirs biological contaminations.

The effects of static magnetic fields used in MR imaging at 0.5 Tesla have been studied on 15 different types of cardiac valves. The displacement of the valves was insignificant at 0.5 Tesla. No significant heating effects was observed with the standard sequences used in cardiac imaging. The image artefacts remain confined to the area immediately surrounding these different valves. It seems possible to perform MRI examinations on patient with the prosthetic heart valves without any risk.

One case of traumatic rupture of the isthmic region of the aorta is reported. Acute ischemia of the inferior limbs, anuria and paraplegia have led to the diagnosis. During the first hours after the trauma bowel ischemia appeared. The repair of the aorta was achieved within the seven hours after the accident but the bowel ischemia stayed irreversible. A such complication has not been reported in the literature as long as we know and we are think that it is possible to range this complication among some of the ischemic enterocolitis.

A left superior veina cava may be troublesome for endocardial lead's placement during permanent pace maker's implantation. We have operated upon one patient with this anomaly. We report the anatomic frequency of this congenital malformation and the technics used to obtain a satisfactory permanent pacing.

Idiopathic mitral valve prolapse due to severe myxoid degeneration may be associated with aortic and/or tricuspid valve disease of the same aetiology. These localisations, which usually give rise few symptoms, can be detected by echocardiography. Sometimes, however, they may give rise to serious valvular regurgitation requiring surgical correction at each diseased valve. The authors report two cases of "floppy" mitral valve prolapse, the first requiring mitral and tricuspid, and the second, mitral and aortic, valve replacement. These cases underline the value of especially by echocardiography, in view of their serious complications.

The artificial left ventricule is placed in the paracardiac position to ensure a short circuit of the natural left ventricule which is left in position. The prosthesis is implanted on the tip of the heart to ensure wide drainage of the left ventricule and on the ascending aorta to obtain systolic injection under physiological hemodynamic conditions. On both sites of implantation are sutured dacron tubes which permit insertion of the prosthesis without interrupting the general circulation and its withdrawal by simple ligature of the tubes of dacron.

A device for assistance of the left side of the heart in acute failure is placed in the paracardiac position. The blood is drained into the apparatus through the apex of the heart and is reinjected into the ascending aorta by an artificial pump. The flow of blood within the prosthesis and at the level of the inlet and outlet values is studied by a system of lighting in thin layers. Several types of original valve have been tested but the most satisfactory results were obtained with a classical bead valve.