Principes de prise en charge de l’hyperglycémie au cours de la nutrition artificielle

The management of hyperglycemia in artificial nutrition requires defining glycemic goals, tailored to the patient, to the type and the sequences of artificial nutrition, establishing patterns of insulin therapy and providing accurate adaptation rules. Above the basal requirement, insulin therapy sufficient to meet caloric exposure must be prescribed appropriate in timing with the artificial nutrition. The use of sliding scale as monotherapy is ineffective. This management requires forming the nurse team.     

Hypertriglycéridémies majeures : diagnostic et prise en charge

Major hypertriglyceridemia or hyperchylomicronemia, defined by plasma triglyceride (TG) concentrations > 10 mmol/L, constitute a heterogeneous group of rare dyslipidemias. Thanks to the progress in the pathophysiological knowledge, patients can be classified into 2 categories: 1/Familial chylomicronemia syndrome (FCS), is a rare form of permanent hypertriglyceridemia, resistant to conventional dietary and therapeutic measures. It is a recessive genetic pathology, due to homozygous or heterozygous composite mutations of genes coding for lipoprotein lipase (LPL) or its regulatory factors; 2/Multifactorial chylomicronemia syndrome (MCS) is more frequent, less severe, combining a polygenic background and comorbidities or environmental factors responsible for hypertriglyceridemia. The main complication of major hypertriglyceridemia is a very marked over-risk of acute pancreatitis with frequent recurrences in FCS, associated with high morbidity and mortality. The cardiovascular risk associated with this pathology is reversed, but recent data support a moderate cardiovascular risk for FCS and a very high cardiovascular risk for MCS. The identification of FCS, facilitated by the FCS Score, followed by a genetic diagnosis by NGS (New Generation Sequencing), is of importance since a new effective treatment with antisense oligonucleotides targeting apoCIII is now available for patients not controlled by a hypolipidic diet and at high risk of acute pancreatitis.     

Mise en place d’un programme de prévention et de prise en charge du diabète en Suisse : le point de vue des patients et des professionnels de la santé

BackgroundA reorganization of healthcare systems is required to meet the challenge of the increasing prevalence of chronic diseases, e.g. diabetes. In North-America and Europe, several countries have thus developed national or regional chronic disease management programs. In Switzerland, such initiatives have only emerged recently. In 2010, the canton of Vaud set up the “Diabetes Cantonal Program”, within the framework of which we conducted a study designed to ascertain the opinions of both diabetic patients and healthcare professionals on the elements that could be integrated into this program, the barriers and facilitators to its development, and the incentives that could motivate these actors to participate.MethodsWe organized eight focus-groups: one with diabetic patients and one with healthcare professionals in the four sanitary areas of the canton of Vaud. The discussions were recorded, transcribed and submitted to a thematic content analysis.ResultsPatients and healthcare professionals were rather in favour of the implementation of a cantonal program, although patients were more cautious concerning its necessity. All participants envisioned a set of elements that could be integrated to this program. They also considered that the program could be developed more easily if it were adapted to patients’ and professionals’ needs and if it used existing structures and professionals. The difficulty to motivate both patients and professionals to participate was mentioned as a barrier to the development of this program however. Quality or financial incentives could therefore be created to overcome this potential problem.ConclusionThe identification of the elements to consider, barriers, facilitators and incentives to participate to a chronic disease management program, obtained by exploring the opinions of patients and healthcare professionals, should favour its further development and implementation.     

Recommandations pour la prévention et la prise en charge des tuberculoses chez les patients traités par infliximab

An unusually large number of cases of tuberculosis, often with miliary or dissemination, has been reported in patients taking infliximab for rheumatoid arthritis or Crohn’s disease. Recommendations have been issued in France regarding the definition of high-risk patients, the screening methods to be used in these patients, and possible prophylactic treatments. The present update is also intended to help physicians manage tuberculosis occurring before or during infliximab therapy.     

Évaluation de l’état nutritionnel au cours de la cirrhose : méthodes,limites et implications

Liver plays a key-role in the metabolism of nutrients. Therefore, liver failure is often associated with malnutrition. It is well established that malnutrition stands as a pejorative factor for prognosis in cirrhotic patients with liver failure. But nutritional assessment is difficult in cirrhotic patients since standard anthropometric and biological indexes are linked with liver dysfunction. We detail here the various causes and mechanisms leading to malnutrition in cirrhosis. We also describe the reliable methods used to assess nutritional state of cirrhotic patients. Finally, we put emphasis on the involvement of nutritional care in cirrhosis and liver dysfunction, describing its specific characteristics and indications.     

Adaptations de la prise en charge des patients en nutrition artificielle à domicile au cours de l’épidémie virale COVID-19 en France : avis du Comité de nutrition à domicile de la Société Francophone de Nutrition Clinique et Métabolisme (SFNCM)

Home artificial nutrition, whether enteral or parenteral, is provided to chronic and fragile patients. The current COVID-19 epidemics may compromise their care at several levels: difficulties to access to hospitals mainly focused on treating COVID-19 patients, possible lack of nurses at home, strong reduction of visits by homecare providers, tended flow or lack of hand sanitizers, surgical masks and pumps. The aim of these recommendations put together by the French-speaking Society for Clinical Nutrition and Metabolism (SFNCM)’s Home Artificial Nutrition Committee is to define in terms of healthcare resources the minimum care to provide to these patients. We also aim to help cope with the possible tensions, in order to secure the care we must provide to home artificial nutrition patients during this crisis.