Influence de la nutrition sur le sommeil et la vigilance

Numerous data suggest that food intake is able to influence sleep and wakefulness. The knowledge on the sleep physiology allows to formulate several hypothesis on the mechanisms involved in the relationship between diet and sleep. It has been observed that enhanced food intake increases sleep duration whereas a reduced food supply decreases sleep duration. Moreover, the nature of nutriment is able to influence wakefulness. A rich carbohydrate meal can decrease vigilance in a subject submitted to sleep deprivation whereas a protein diet can improve psychocognitive performances in such a situation. The physiological mechanisms suggested to explain the role of volume and nature of a meal are related with the role of nutriment on neuromediators metabolism or the hormonal changes induced by the feeding pattern. From a practical point of view the knowledge of the diet impact on sleep and wakefulness may be useful in the management of healthy subject and also of consequencies of metabolic diseases.     

Aspects métaboliques de la dénutrition au cours de la maladie VIH

The Wasting Syndrome (WS) is one of the major aspects of the acquired immunodeficiency syndrome (AIDS). Fat free mass, the amount of functionnal protoplasm in non adipose tissue is an independent predictor of death in AIDS patients.The deficit of the energy balance could be the result of decreased caloric intake and/or increased energy expenditure. Elevated Resting Energy Expenditure (REE) has been reported in the early stage of the HIV infection. Patients with AIDS who had active secondary infection had a striking average weight loss resulting of the combination of anorexia and dramatic elevated REE. The role of cytokines in the WS was proposed in reason of the in vitro and in vivo metabolic disturbances induced by these cytokines. The difference studies suggest that synergistic interactions between cytokines may be necessary for developping the WS.     

Mécanismes de la dénutrition au cours de l'insuffisance respiratoire chronique

The study of the mechanisms of denutrition during chronic obstructive pulmonary disease is useful because this common evolutive complication has severe functional consequences and is associated with a poor prognosis, irrespective of respiratory functional status. Conversely, renutrition improves the prognosis in these patients. Adaptation to hypoxia, the basis of which is oxygen conformance, is described. Denutrition during chronic obstructive pulmonary disease is linked to the imbalance arising from increased energy expenditure and inadequate food intake. The origins of the imbalance are discussed. The clinical implications of knowing the mechanisms of denutrition are set out and perspectives for both experimental and applied research are proposed.     

Restauration de la masse maigre par l'administration de facteurs de croissance lors de la dénutrition sévère associée au VIH

Body wasting, particularly loss of lean body mass (LBM), is a frequent complication of human immunodeficiency virus (HIV) infection and has been associated with impaired quality of life, accelerated disease progression, and reduced survival. The failure of nutritional or appetite-stimulating therapies to consistently restore LBM has prompted investigation of specific protein anabolic hormones as potential therapies for HIV-associated wasting. Treatment with pharmacologic doses of recombinant human growth hormone (rhGH) resulted in weight gain and nitrogen retention in a short-term metabolic ward study. Furthermore, rhGH induced sustained increases in weight and LBM, accompanied by decreases in fat, during a 12-week placebo-controlled multicenter trial. Recombinant human insulin-like growth factor-I, which is believed to mediate the protein-anabolic effects of rhGH, improved nitrogen balance only transiently during a metabolic ward study. In placebo-controlle multicenter trial, a combination of rhIGF-I with low doses of rhGH produced an increase in LBM that was less than half of that achieved with pharmacologic doses of rhGH alone during a comparable study period. Preliminary studies of testosterone and its derivatives have demonstrated increases in weight and LBM in patients with HIV infection. At this time, in double-blind, placebo-controlled trials, only pharmacologic doses of rhGH have produced sustained increases in LBM. Future studies of the use of growth factors in patients with HIV-associated wasting should be designed not just to evaluate the best ways to use these agents, but also to determine whether clinically relevant functional benefits accompany increases in weight and/or LBM.     

El coste de la aplicación de la Ley de Dependencia a la enfermedad de Alzheimer

Aim

To calculate the formal cost of social care for people with Alzheimer disease according to the implementation of the dependency law in Gipuzkoa (Spain).

Method

A retrospective observational study was carried out of the database of the Dependency Care Services of Gipuzkoa from 2007 to 2012, using a prevalence-based bottom-up approach.

Results

The average annual formal cost per person was €11,730. The annual population cost was €34.7 million, representing 19% of the annual expenditure corresponding to the dependency law and 29% of the total cost of Alzheimer disease.

Conclusions

Despite the implementation of the new law, most of the burden of the disease is bourne by the family.     

Influencia del criterio de selección de pacientes para la toma de frotis en la estimación de la efectividad de la vacuna antigripal

Objective

To estimate the effectiveness of the influenza vaccine under different criteria for selecting patients for swabbing.

Method

A case-control study was performed of laboratory-confirmed cases (n = 909) and negative controls for influenza (n = 732) in the 2010-2011 to 2012-2013 seasons in Navarre (Spain). The adjusted vaccine effectiveness was estimated by including all swabs from patients with influenza-like-illness and selecting only the first two cases per physician and week.

Results

The first two patients per physician and week were less frequently vaccinated against influenza (7.9% vs. 12.5%, p = 0.021) and less often received confirmation of influenza (53.6% vs. 66.4%, p <0.001) than subsequent patients. These differences decreased after adjustment for covariates. The effectiveness of the influenza vaccine was 49% (95% CI: 23-66%) when all swabs were included and was 55% (95% CI: 27-72%) when we selected the first two swabs per week and physician.

Conclusion

The selection of the first two patients per physician and week may bias assessment of the effectiveness of the influenza vaccine, although this bias was small in the seasons analyzed.