Évaluation nutritionnelle chez le dialysé

Malnutrition is common among patients with end stage renal disease treated by hemodialysis or peritoneal dialysis. It is a major cause of morbidity and mortality. Nutritional status may be assessed by several clinical markers including dietary records, anthropometric measurements and subjective global assessment. Among biochemical parameters, albumin is the most commonly examined nutritional index and transthyretin the most useful. Protein catabolic rate reflects dietary protein intake. Body composition analysis by bioelectrical impedance analysis or better by dual energy X-ray absorptiometry offers a reasonable estimation of body compartments such as total body water, fat mass and lean body mass. Periodic assessment of nutritional status must take into account the limitations of all the criteria used.     

Évaluation d’une consultation mobile d’infectiologie

Objectives

The aims of our study were to characterize the activity of a remote infectious diseases consultation (RIDC) in a teaching hospital and to assess physician observance to advice.

Design

All demands received by the RIDC for initial advice and the given answers were recorded during one month. Advice given for inpatients was followed up 72 hours after to evaluate the physician's observance.

Results

Six hundred and nineteen demands were recorded: 47% came from our teaching hospital and 53% came from community practice. Hospital demands came mostly from surgical (47%) and medical (41%) units. Most of them (92%) were related to the treatment of an infection or diagnostic help. Outside calls came from doctors (85%) either private or working in a health care institution. Prophylaxis (47%) and treatment of an infection or a diagnostic help (43%) were the most frequent issues. Among the 176 pieces of advice requested for inpatients, 87% were completely observed. Advice was more followed when it was given by experienced specialists (p = 0.02) or by phone (p = 0.03) and less followed for patients presenting a nosocomial infection (p = 0.03).

Conclusions

The RIDC is very useful for the medical community and its advice is usually followed. Informal consultations account for an important part of its activity.     

Éducation nutritionnelle destinée à des patients migrants dialysés

The unit of hemodialysis of the hospital Saint-Louis - Paris accomodates a significant migrant population, mainly stemming from West Africa, Southeast Asia and Maghreb.A study carried out in the service near the dialysed migrant patients highlights that their culture of origin is seldom taken into account in the diffusion of the nutritional messages, which prove to be unsuited. However the environment of these patients, at the same time on a socio-economic, medical, linguistic and even psychological point of view, requires a specific approach.The set up of a program of nutritional education dedicated to the migrant patients was thus justified.     

Évolution des disponibilités alimentaires à la réunion Depuis 1975

In the last decades in Reunion Island, dramatic changes occurred in the way of life, especially in food consumption. We calculated annual food availability in kg/inhabitant/year, between 1975 and 2002. We evaluated for each year, mean daily energy availability per inhabitant and the nutritional structure of the meal. In 27 years, the increase of meat and milky products availability led to an increase of the part of fat and animal proteins. In the same time, part of carbohydrates decreased in spite of the rise of simple sugar. High prevalence of diabetes and obesity observed in Reunion Island is probably linked to rapid westernization of food. Actions of prevention based on the Programme National Nutrition Santé should continue to face this phenomenon.     

Épidémiologie des kystes hydatiques extrapulmonaires : 265 cas en Tunisie

Aim of study

The authors wanted to analyze the epidemiological features of extrapulmonary hydatid cysts and compare their results with those reported in literature.

Methods

Two hundred and sixty-five cases of extrapulmonary hydatid cysts collected from 1990 to 2007 were retrospectively studied.

Results

One hundred and one male and 164 female patients (sex ratio M/F = 0.61 mean age 38.7 years) were included. In our series, hydatid cysts involved mainly the kidney (24.1%), the central nervous system (22.6%), the liver (19.6%) and the spleen (11.3%).

Conclusion

Contrary to published data, our results show that hydatid cysts of the kidney and of the central nervous system are more frequent than hepatic location which ranks 3rd. Such unusual results may be due to a selection bias.     

Évaluation et gestion des risques–Matériaux d’emballage à contact alimentaire

Food contact materials play an essential role in the food conservation and protection. They are characterized by a constant innovation such as the development of active and intelligent materials. They have also a very important marketing function and have to be recoverable. The ability of materials to be on contact with the food is assessed on the constituents initially introduced in a formulation (European Regulation No. 1935/2004). The objective of this article is to examine how better evaluate the risk associated with neoformed products which could appear during the manufacturing process of packaging or a potential “mixture” effect.     

Évaluation et prise en charge des troubles de la déglutition

Swallowing is a complex phenomenon, allowing per os feeding but with a protection of respiratory tract. Swallowing disorders are frequent, involve liquids, solids or theses two textures, and are mainly caused by neurological or otorhinolaryngological diseases. They may have severe consequences, like an alteration of quality of life for patients or their relatives, an increased risk of aspiration, of malnutrition or dehydration, and finally a possible decrease of survival. Assessment includes careful questioning and physical examination. The reference complementary investigation is videofluoroscopic evaluation. Nutritional assessment is mandatory. Taking care of swallowing disorders in a multidisciplinary manner is recommended, with interventions of physician, speech therapist, dietician, sometimes dentist or surgeon, and needs a strong contribution of the paramedical staff and the patient relatives. Enteral nutrition is recommended when repeated or severe respiratory complications occur, when the nutritional status is altered in spite of feeding enrichment, modulations of textures or use of oral nutritional supplements, or when the meals are too long.     

Érythème noueux unilatéral associé à une leishmaniose cutanée homolatérale

Objective

The authors wanted to report an uncommon etiology of erythema nodosum.

Case report

A 45-year-old woman presented with numerous encrusted nodular lesions on the left leg and arm. Leishmania was identified after a parasitological examination. Subcutaneous erythematous nodules developed later on the same leg. Erythema nodosum was diagnosed with a biopsy of the nodules. The patient was treated with systemic meglumine 60 mg/kg per day for 13 days. All lesions improved under treatment.

Discussion

This was the first reported case of unilateral erythema nodosum with cutaneous leishmaniasis. Clinical and laboratory exams were in the range of normal and led the authors to exclude common causes of erythema nodosum. Subcutaneous nodules occurred before the beginning of treatment with meglumine. Thus, drug allergy (previously reported) was excluded as an etiology of EN.     

Évaluation des sites francophones spécialisés dans l’obésité accessibles au public

Obesity has now become a major public health issue. Obese people have at their disposal a huge amount of information and search for data related to their disease increasingly via the internet, while they don’t have sufficient medical knowledge.Using net scoring we have selected the ten best web sites dealing with obesity, in compliance with strict/harsh requirements. They include quality contents even though they might be criticised somehow. The internet must remain a means of finding help and advice for obese people. This source of information for motivated people, is an additional tool but cannot replace a traditional health care system.     

Morphologie et alimentation de l’enfant : Évolution au cours des dernières décennies

Growth is a favourable period to study the association between environmental factors and body composition, as many body parameters can be investigated. The analysis of secular trends in nutrition and growth could suggest hypotheses about the factors responsible for the body parameter changes over time.We have conducted several studies at different periods to assess secular trends. We also have developed growth indicators such as the BMI growth curves, the adiposity rebound and the arm muscle and arm fat areas.Since many years, increased stature has been recorded in various countries. The same trend was recorded in our studies. Mean stature in 2000 was 1.31m and 1.30m in 8-year-old boys and girls respectively. In 1960, in the French reference study, these figures were 1.27 and 1.26m, corresponding to a 4cm increase over the last 40 years. A comparison between two longitudinal studies conducted 30 years apart, indicates that the higher stature recorded at adult age in the more recent study, mainly results from an increase stature in early life. This increase mainly results from increased leg length. Birth weight recorded in studies conducted at different periods did not reveal any changes. By contrast, in school children, an increase in weight has been recorded in the last decades. Studies conducted in 10-year-old children at different time periods revealed that the prevalence of overweight defined by the 97^th centile of the French reference values was about 3% in 1965, 6% in 1980, 12% in 1995 and 16% in 2000. The age at adiposity rebound was 6.2 years in children born in 1965 and 5.6 in those born 30 years later. The earlier rebound recorded in the more recent study reflects an acceleration of growth.While children are taller, fatter, and grow faster, mean energy intake decreases over time, particularly due to a decrease in fat intake. The infant diet in many countries (by the age of 6-12 months) is characterised by high levels of proteins and low levels of fat. The high protein diet in infancy could explain the rapid growth process observed nowadays. Various studies have suggested that an accelerated growth in early life is associated with risk factors. Like in adults, obesity in children, is associated with metabolic diseases.In conclusion, growth is the period when environmental factors can have long lasting influence on body composition. The secular trends reported in many countries, such as increased stature, accelerated growth or the increasing prevalence of obesity, could result from influences taking place early in life. It is then important to develop research focussing on the identification of the early environmental factors which influence adult health.