Dénutrition chez l’enfant et l’adolescent obèse

Recently, childhood obesity, defined by an excessive fat mass, has become a major public health problem due to its steady increased prevalence over the last thirty years and its long-term complications if it persists during adulthood. Although malnutrition is rare in obese children, this population is at risk for iron and vitamin deficiencies. Hypovitaminosis D affects more than one in three children and requires systematic supplementation per 100,000 IU of vitamin D every three months. Iron deficiency is common as described in the pediatric population and must be detected. Specific vitamin of group B deficiencies is also described but is more rare. In addition, with the emergence of bariatric surgery in teenagers with sleeve gastrectomy or gastric by-pass, the risk of malnutrition will increase throughout life, especially in the case of poor compliance with vitaminic supplements as observed in adults.     

Accidents d'exposition au sang chez les étudiants en médecine

Objective – We expose the results of a questionnaire survey among medical students in Strasbourg medical school about the standard precaution knowledge, the prevention of blood exposure accident methods they usually applied and the circonstances of the possible blood exposure accident they already have been victims.Design – Anonymous questionnaire is delivered to second, third and fourth years studies of the second cycle of medical study students.Results – Thirty percent of student of third and fourth years studies who already have clinical practice described blood exposure accident during their hospital activities. Sutures was the first accident circonstance described (45%), blood drawing for gas measurment was the second in frequency (24%). Only 45% of these accidents were reported but serology control was purchased in 71% cases. Students were questioned about gloves wearing during invasive medical care, 50% of them don't used any protective gloves. Sixty seven percent of students resheathed needles and only 30% personnally disposed of needles in sharps bins.Conclusions – The incidence of blood-exposure accidents in hospital medical students is high. Measures should rapidly implemented to inform and train students on prevention and learn safety technical action.     

Malabsorption et intolérance au lactose chez l’adulte

The milk sugar lactose is a disaccharide, which is hydrolyzed in the intestine by the brush border enzyme lactase in free glucose and galactose to be absorbed by the small bowel wall. Low lactase activity allows undigested lactose to reach the colon where the anaerobic activity of bacteria yields different products. These are principally short chain fatty acids, hydrogen, carbon dioxide and methane, responsible for symptoms mainly consisting in abdominal pain, bloating, flatulence and diarrhea. Lactase deficiency may be genetically mediated or acquired after weaning or secondary to diseases injuring the small bowel mucosa, such as celiac disease, enteritis or Crohn's disease. Lactose malabsorption is due to lactase deficiency and its clinical expression is lactose intolerance: in clinical practice, lactose malabsorption is diagnosed by the hydrogen breath test (HBT) that should be accompanied by the collection of intolerance symptoms possibly provoked by HBT. The treatment is lactose avoidance/reduction in the diet: this approach could be reserved to symptomatic patient (“intolerants”). Dietetic advice should aim to ensure nutritional adequacy of the diet and to avoid nutritional deficiencies, in particular due to a lower calcium intake.     

Complications hépatobiliaires associées à l’insuffisance intestinale chez l’adulte et l’enfant

The treatment of chronic intestinal failure, of which the main cause is the short bowel syndrome, is based on parenteral nutrition. Intestinal failure-associated liver disease, which may worsen toward cirrhosis, is the most threatening intestinal failure-associated complication. Risk factors for intestinal failure-associated liver disease are related to parenteral nutrition modalities and to the underlying disease. Bowel rest and short bowel syndrome are risk factors for biliary lithiasis. Steatosis is mainly secondary to nutritional factors (excess of glucose and/or lipids, continuous parenteral nutrition). The main risk factors of cholestasis are intestinal resection, intestinal bacterial overgrowth, excess of long-chain polyunsaturated ω6 fatty acids and phytosterols from some lipid emulsions. Liver chronic inflammation, another risk factor for intestinal failure-associated liver disease, is related to recurrent infections, bacterial or toxinic translocation, high intake of long-chain polyunsaturated ω6 fatty acids as precursors of inflammatory mediators. Fibrosis, secondary to any lesions, could progress toward cirrhosis with portal hypertension and liver failure. In such condition, the only life-saving treatment is a combined liver-intestinal transplantation. The prevention is based on the identification of patients with high risk of complicated liver disease, and on the optimal management of both underlying disease and parenteral nutrition. Routine surveillance is based on biological markers of variable sensitivity and specificity, and ultrasonography. Liver biopsy is required to diagnose fibrosis, especially prior to decide for an isolated intestinal transplantation or combined intestine-liver transplantation.     

Activité physique et santé chez la personne âgée : évidences et recommandations

The number of older subjects increases and the aging of the population represents a major public health issue. In older subjects, physical activity plays a major role for maintaining functional capacities. Yet, in the literature, most articles are about positive effects of physical activity in the general population but few are specific to older subjects. This article aims at reviewing the present knowledge on this topic and the recommendations provided by expert association for this population. Regular and adapted physical activity with endurance, resistance, balance and flexibility exercises is recommended for health benefits. However, further studies are required to better define the characteristics of the physical activity in terms of frequency, duration and intensity to improve health.     

Troubles des conduites alimentaires : prévalence et facteurs de risque chez des étudiants en médecine tunisiens

ObjectivesYoung students, in particular those in the medical field, seem to be at risk of developing psychiatric disorders, especially eating disorders (ED).We aimed to determine the prevalence of ED in Tunisian medical students and to study the risk factors associated to it.Materials and methodsWe conducted a cross-sectional study at the Tunis medical university including 250 students. Each student filled out a self-administered questionnaire with the necessary individual information as well as the HAD (Hospital Anxiety and Depression) scale assessing anxiety and depression, EDI2 (Eating Disorder Inventory 2) assessing the cognitive behavioral profile of participants and PSS (Perceived Stress Scale), assessing their level of perceived stress. Eating disorders were screened using the EAT40 and BITE self-questionnaires. We used the DSM-5 classification to specify the types of ED.ResultsThe sex ratio (M/F) was 0.4. Anxiety, depressive symptoms and high stress level were found in 34%, 17% and 75.2% of cases, respectively. The prevalence of ED was 16.4%. Independent factors associated with ED were female sex (P = 0.009), physical activity (P = 0.04), body dissatisfaction (P < 0.001) and the feeling of ineffectiveness (P = 0.032). The risk of ED was five times higher in students using anxiolytics (P < 0.001), laxatives (P = 0.046), or induced vomiting (P = 0.045) and 9.55 times higher in students on a diet (P < 0.001).ConclusionThese results justify the need for systematic screening for ED in medical students in order to ensure early and effective treatment and thus preserve the physical and mental health of future caregivers.     

Troubles d’acquisition de la lecture en cours élémentaire : facteurs cognitifs,sociaux et comportementaux dans un échantillon de 1062 enfants

BackgroundReading impairment is the major learning disability in children. While research on illiteracy has mainly been conducted from a sociological perspective, research on dyslexia has typically been studied from a cognitive-linguistic perspective. Studies that jointly investigate sociological, behavioral and cognitive factors in predicting reading outcome are rare and limited to English-speaking populations. The goal of the present study was to screen second grade children with reading impairment in French urban elementary schools and to pin down the factors that explain the various facets of reading failure and success.MethodsA total of 1062 children from 20 different schools in the city of Paris participated in the study. Different aspects of reading were assessed individually for children with a suspected impairment in reading acquisition. Subsequently, 131 poor readers and 50 typically developing readers were matched for sex, age, and school. For these children, medical, cognitive, behavioral and individual socioeconomic data were obtained. Group differences were examined and multiple regression analyses were conducted to examine how much variance in reading was explained by the various variables.ResultsThe prevalence of poor reading skills in grade 2 was highly influenced by neighborhood socioeconomic status (SES) (ranging from 3.3% in high SES to 20.5% in low SES areas). Among the SES variables, employment of the father was a significant predictor of poor reading. Among the cognitive variables, phonological awareness and rapid naming were the most significant factors, much more than verbal or nonverbal intelligence. Among the behavioral variables, attention was an important factor but not externalized symptoms. Multiple regression analyses showed that reading outcome was best predicted by phonological awareness skills and attention deficits.ConclusionThe majority of children with reading disability come from low SES areas. As in the English literature, the most robust predictor for reading impairment is phonological awareness, even when SES is taken into account. In addition, attention deficits seemed to aggravate reading impairments for children with weak phonological awareness skills. Successful early prevention should focus on reinforcing phonological awareness, recoding and attention skills.