Dépister la dénutrition de l’enfant

Protein energy malnutrition (PEM) occurs when energy and protein intake do not meet requirements. PEM increases both morbidity and mortality of a given disease. The Nutrition Committee of the French Paediatric Society recommends weighing and measuring any child when hospitalized or seen as outpatients. Body mass index (BMI) must be calculated and analyzed according to references anytime growth kinetics cannot be analyzed. Any child with a BMI below the third centile or –2 standard deviations for age and sex needs to be examined looking for clinical signs of malnutrition and signs orienting toward an aetiology, and requires having his BMI and height dynamics plotted on a chart. PEM warrants drawing a nutritional strategy along with the global care plan. A target weight needs to be determined as well as the quantitative, qualitative and modality of nutritional care. This plan must be evaluated afterwards in order to adapt nutritional therapy.     

Diffusion des recommandations de la Conférence de consensus sur la prophylaxie de l’endocardite infectieuse

A card holding specific data was edited to ensure an optimal distribution of Consensus Conference recommendations for the prophylaxis of infectious endocarditis. It is given by cardiologists to their patients with risk heart diseases. It gives information only on antibiotic prophylaxis for dental care and must be presented to the dentist. Articles in medical, paramedical, and public magazines have reported the recommendations and promoted this card. In 9 years, 273,244 cards have been handed out and may be from 84,000 to 210,000 were really given to patients. Surveys show that it is known by 97% of cardiologists, but only by 55% of dentists and 28% of GPs. Enquiries made on patients having received a card show that they have acknowledged and used it, including for those who have held it for a long time.     

Dépister la dénutrition de l’enfant en pratique courante

Protein energy malnutrition (PEM) occurs when energy and protein intake do not meet requirements. It has a functional and structural impact and increases both morbidity and mortality of a given disease. The Nutrition Committee of the French Pediatric Society recommends weighing and measuring any child when hospitalized or seen in consultation. The body mass index (BMI) must be calculated and analyzed according to references any time growth kinetics cannot be analyzed. Any child with a BMI below the third centile or ?2 standard deviations for age and sex (1) needs to be examined looking for clinical signs of malnutrition and signs orienting toward an etiology and (2) requires having his BMI and height dynamics plotted on a chart. PEM warrants drawing up a nutritional strategy along with the overall care plan. A target weight needs to be determined as well as the quantitative and qualitative nutritional care as well as its implementation. This plan must be evaluated afterwards in order to adapt the nutritional therapy.     

Physiopathologie de la candidose oropharyngée au cours de l’infection par le VIH

Candida albicans (C. albicans), which is a part of the normal microbial flora, is a yeast-like fungus that colonizes human mucosal surfaces. Adherence to epithelial cells is the first step in the physiopathology of mucosal candidosis. Secreted aspartic proteases play an important role in this first step, but they are also involved in tissue invasion process and in phagocytosis alteration. Cell-mediated immunity initiated by CD4+ T cells is the predominant host defense mechanism against C. albicans infections at mucosal surfaces. TH1 cells play a major role, producing cytokines that activate antifungal function of phagocytic cells (IFN-γ). The reduced CD4 + T cell number and the shift from TH1- to TH2-type response during HIV infection are thought to be important in the development of mucosal candidosis. Other mechanisms, such as increased aspartic proteases secretion, also contribute to the pathogenesis of C. albicans in HIV-positive individuals. Recent studies of Candida pathogenesis in HIV-infection have increased understanding of the dramatically lower rates of oropharyngeal candidosis in individuals receiving HIV protease inhibitor. Therefore, the research on specific aspartic protease inhibitors should be of interest for the treatment of mucosal candidosis.     

Régulation de la balance énergetique : ajustement de l’apport alimentaire à la dépense énergétique

Studies investigating the effect of exercise on body composition, as well as studies investigating the effect of exercise on ad libitum energy intake, provide insight into the association between exercise and energy balance. Reduced levels of physical activity does not exhibit a compensatory reduction of energy intake, and lead to a positive energy balance, most of which is stored as body fat. By contrast, high intensity exercise performed on regular basis increases energy intake in highly trained subjects and lean individuals. Obese untrained persons commonly do not change energy intake when exposed to exercise training. It can be concluded that regular high level of physical activity increases food intake secondary to excess body fat storage utilization, and thus serves as an effective strategy for obesity reduction. The physical activity recommendations for clinically significant weight loss are discussed herein.     

En quoi l’industrie pharmaceutique contribue-t-elle à l’amélioration de la qualité en antibiothérapie ?

Do studies made by the pharmaceutical industry contribute to improving quality in antibiotic therapy? In addition to conventional preclinical studies, structure-toxicity and pharmacotoxicological studies help select antibiotics that are better tolerated. Microbiological studies determine the antibacterial spectrum, the critical concentration values to sort clinical strains, and the incidence of resistance of these strains in Europe. Continuing efforts to achieve standardization are still necessary in order to carry out genuine European studies. A number of clinical recommendations (CPMP, ICH, ESCMID, FDA) have been issued in the past few years (investigations for drug interactions, choice of comparator, conduct of non-inferiority trials...) that standardize studies and make the results increasingly reliable. Can marketing contribute to improving quality in antibiotic therapy? Promotional documents, which have to be validated in France by the Publicity Commission so as to discourage drug misuse or over consumption, have progressively improved so as to communicate a message that is consistent with the summary of product characteristics and the recommendations for appropriate use. Medical training, partnership without reciprocal obligations, and sponsorship also contribute to a better quality of antibiotic therapy. Research is making progress: the genome of the main bacteria has been sequenced, and thanks to genomics and proteomics, in the near future there will be new antibiotics, free from any cross-resistance put on the market. This, combined with the production of detection kits for biological markers of infection and of new vaccines, should contribute to an improvement in the quality of antibiotic therapy.