Bécégite généralisée : étude de quatre observations

Inoculation by the BCG in the birth is compulsory in our country since 1959. Adverse reactions induced by vaccination with the BCG are rare varying from zero to 23.8%. Spread infections are even rarer and their estimated incidence is 0.1 to 4.3 per one million vaccinated children. The fatal disseminated BCG infection is exceptional and affects especially the children presenting an immune defect. The role of a familial gene defect needs to be taken into consideration. The BCG osteitis is found in second position in clinical forms after the suppurative lymphadenitis; it arises generally five months to five years after the vaccination. We report four observations of disseminated BCG infection occuring in children from three months to four years with a mortal evolution in two cases. Our objective is to discuss pathologic aspects of BCG disease.     

Dénutrition chez le sujet âgé obèse

The aging population grows quickly, the prevalence of obesity increases in all age categories, and the prevalence of disease and disease related malnutrition is bound to increase with age. In subject aged 70 and older, the prevalence of obesity is 15 to 17 % and the prevalence of malnutrition is 4 to 10 %. The number of older persons both obese and malnourished has not been estimated, and there are no specific recommendations for nutritional care. Nevertheless, the obese older subjects can be frail, sarcopenic or malnourished and thus present a high risk for mobility disorders, falls, fractures, hospitalization and institutionalization. Data from the literature may help practitioners to diagnose and care for these older persons.     

Comment gérer la nutrition artificielle chez un patient diabétique ?

Hyperglycaemia in patients receiving enteral or parenteral nutrition is a major problem due to its high prevalence and possible consequences in terms of morbidity and mortality. However, the management of diabetes/stress hyperglycaemia during artificial nutrition remains largely unknown, especially in non-critically ill patients. The indications and access routes for artificial nutrition are not different in patients with diabetes/stress diabetes than in non-diabetics. We do not recommend using enteral formulas designed for patients with diabetes. The glycaemic objective must be individualized. We recommend a preprandial blood glucose levels between 100 and 140 mg/dL (5.5 and 7.8 mmol/L) and postprandial levels between 140 and 180 mg/dL (7.8 and 10 mmol/L). A frequent monitoring of capillary glycaemias is mandatory. The best drug treatment for treating hyperglycaemia/diabetes is insulin and we recommend to adapt the theoretical insulin action to the nutrition infusion regimen. The management of these patients needs the help of a multidisciplinary experimented staff.