Retinal vasculitis in lupic disease

Three cases of retinal vasculitis in SLE-type diseases are reported. The first was central retinal vein occlusion occurring during clinical remission of SLE in a 55 year old black female. Prednisone maintenance therapy was unchanged and visual loss rapidly regressed with heparin therapy. The second case was a 33 year old black female in whom SLE was discovered following relapsing bilateral optic neuritis. A progressive visual improvement was obtained with high dose of prednisone (1 mg/kg/day). The third cas was a 17 year old white girl with retinal vasculitis. She had an unclassified connective tissue disease inaugurated by optic neuritis at the age of 10. High dose prednisone (1 mg/kg/day) was effective on the visual loss. Retinal vasculitis lesions in SLE and their therapy are reviewed.     

Anthropometric and biological evaluation of 44 patients with protein-calorie malnutrition

In industrial countries protein-calorie malnutrition (PCM) is a frequent cause of hospital morbidity and mortality. In this study, 88 hospital patients were evaluated: 44 (25 men and 19 women) aged from 20 to 80 years) with PCM, and 44 without malnutrition; the two groups were matched with regard to sex, age and height. The following parameters were determined: arm muscle surface, whole-body muscle mass, proportion of body fat, serum albumin (Alb), prealbumin (PA), retinol-binding protein (RBP), transferrin, thyroxine-binding protein, thyroxine, triiodothyronine, reverse triiodothyronine and total complement. Anthropometric measurements were validated by planimetry of a computerized tomographic section of the arm in 60 patients. There were significant differences between the two sexes in anthropometric values. Alb, PA and RBP values were different in men and RBP only in women; all other biochemical parameters were the same in both sexes. Thus, the group with PCM could be distinguished from the control group by anthropometric values and RBP values. Anthropometric parameters have been reported as being more specific of PCM than biochemical parameters, but since the latter are considered more sensitive, both complement each other and must be taken into account.     

Hypocaloric and high-protein diet in obese patients: changes in the lean mass

We have followed for 40 days seven hospitalized, young (age, mean SD : 33 +/- 8 yrs), and moderately obese (W/H : 35 +/- 3.92) women. During the first 5 days (DO to D5) they received a diet similar to their customary home-diet; from D6 to D40, their daily caloric intake was adjusted to 3,41 +/- 0.13 MJ (816 +/- 30 kcal). This diet comprised 21 p. 100 of sugars, 35 p. 100 of lipids, 1.57 +/- 0.09 g proteins per kg ideal body weight. Five seven-day periods have been studied. On the first day of each period, we recorded body weight and measured plasma albumin, pre albumin, retinol binding protein, complement (CH50 and C3) C peptide (in the fasting state and after glucagon stimulation), and thyroid hormones (T3 and rT3). On each of the 35 days of this study, total nitrogen was measured (Kjeldahl's method) in food, urine and faeces. On D0 and D41 lean and fat body masses were evaluated through measurements of total water (dilution of tritiated water) and of skin fold thickness respectively. From D0 to D40, the average weight loss was 8.76 +/- 1.86 kg; the cumulated nitrogen balances were negative in 6 patients and positive in one, with variations from one period to another and from one patient to another. Plasma proteins and hormones did not vary significantly. Changes in lean mass were comprised between + 0,7 and -- 1,6 kg in spite of the fact that all patients received the same caloric and protein intake.     

Rare genetic causes of obesity: Diagnosis and management in clinical care

Rare genetic forms of obesity are linked to impaired energy balance (i.e., eating behaviour and energy expenditure) involving hypothalamic pathways. More than 60 genes coding for proteins located in the hypothalamic leptin/melanocortin pathway contribute to the development of these rare forms of obesity. The ambition of the French National Protocol for the Diagnosis and Care (PNDS) of Obesity of Rare Causes was to establish practical recommendations for assessment and management at all ages. This report is available on the website of the French Health Authority (HAS). In addition to severe obesity, patients often display obesity-related comorbidities and neuropsychological/psychiatric disorders. These complex conditions make clinical management particularly challenging. Early diagnosis is critical for the organization of coordinated specialized multidisciplinary care, with mandatory interaction between caregivers, social partners and families. Strategies to prevent aggravation of obesity consist in limiting access to food, establishing a reassuring daily eating environment, and the practice of sustained adapted supervised daily physical activity. The implementation of genetic diagnosis in clinical practice now enables a personalized medicine approach with access to new drug therapies, and improves the analysis of the risk/benefit ratio of bariatric surgery.