La mesure du métabolisme de base reste fondamentale pour établir les apports énergétiques conseillés aux patients obèses

Three methods for evaluating the resting metabolic rate (RMR) in obese patients have been compared with the reference technique measurement: indirect calorimetry. The methods were the calculation of RMR by Harris and Benedict's and Black's formulas, and by bioelectrical impedance analysis (BIA). In the same patients, the level of recommended energetic intakes obtained from the dietetic evaluation was compared with the ideal level given by the calorimetric RMR. Bioelectrical impedance analysis and Harris and Benedict's formulas gave mean results non significantly different from indirect calorimetry, but with a high risk of dispersion, and they were consequently unusable in daily practice. Black's formulas significantly underestimated RMR. The dietetic evaluation proposed a too high level of energetic intakes, with a risk for the patients of inefficiency. The calorimetric RMR measurement is still a base for obtaining the level of energetic intakes recommended to obese patients.     

Le blues du mangeur: Comment manger sans pécher ?

For human consumers, eating means more than simply obtaining nutrients. Following millenaries of food shortages, the present-day plethora associated with industrialized and globalized production has changed the food situation and exposed human consumers to dangers for which they are not prepared, among which obesity is the most obvious. Food behavior and weight “norms” recommended by experts might have done more harm than good. A consequence of the restrictive diets proposed by medical dietetics for over half a century is “cognitive restraint”, which favors eating disorders as well as weight gain, and compromises the quality of life of obese individuals confronted by social stigma. Nutrition specialists who have remained aware of human heterogeneity and complexity, denied by the orthodox dogma supported by international medical dietetics, have proposed promising options for both treatment and prevention.     

Défaillance multiviscérale et infection disséminée à adénovirus

Background

Peripheral blood stem cell transplantation is a frequent option, especially for patients with hematological malignancies.

Case reports

A first patient received this treatment for acute myeloblastic leukemia, the second for Richter's syndrome (follicular lymphoma). In both cases, allograft (unrelated donor, non myeloablative conditioning) was followed by graft versus host disease (GVH) requiring an immunosuppressive treatment. Respectively 15 and three months after graft, these two patients presented with multiple organ failure including very severe hepatic dysfunction. The diagnosis was made according to positive blood PCR, positive BAL, and hepatic histological findings.

Discussion

Adenoviruses, frequent in pediatrics, can be responsible for extremely severe infections among immunocompromised adults. T lymphocyte depletion plays a key role.

Conclusion

Adenoviral infections can be fatal among immunocompromised patients. Diagnostic improvement should lead to early treatment, which however, remains to be clearly defined.     

Le tissu adipeux : un donneur de cellules souches ?

Several laboratories have shown that the cells from the stroma-vascular fraction of the human adipose tissue express, depending on cell culture conditions, biochemical markers of multiple cell lineages including adipogenic, osteogenic, chondrogenic, myogenic, endothelial, neuronal and epithelial cell lineage. Furthermore, various in vivo approaches revealed the ability of the cells derived from the stroma-vacsular fraction of adipose tissue to repair ischemic or damaged tissues. Altogether these data strongly suggest that the stroma-vascular fraction of the human adipose tissue contains cells that exhibit properties like stem/progenitor cells. However, the exact nature of the cells, their potentiality to lead to differentiated cells in vivo as well as the mechanisms involved in their repair capability remain to be characterized to consider their use in regenerative and reparative medicine.     

Lésions cérébelleuses réversibles et neuropathie périphérique induites par le métronidazole

Introduction

Metronidazole is a widely prescribed treatment for amoebic and anaerobic germ infections. Its neurologic toxicity is rare but can be serious.

Case report

We report the case of a 27-year-old male patient, treated with metronidazole for a cerebral abscess. He presented with a cerebellar syndrome and peripheral neuropathy at a cumulative metronidazole dose of 60 g. The MRI aspect of the cerebellar lesions in addition to their reversibility after treatment cessation led to the diagnosis of metronidazole induced neurologic toxicity.

Conclusion

The occurrence of neurologic disorders in patients treated with metronidazole must suggest drug toxicity and lead to cessation of treatment.     

Alimentation, activité physique et surpoids chez des enfants de l’est Algérien

The prevalence of overweight and obesity were measured in a sample of 251 children aged 8 to 12 year in an urban area of the Eastern part of Algeria. IOTF references are used in order to define overweight and obesity.The overall prevalence of overweight and obesity is 21.5 %. 15.9 %. Overweight alone is found in 15.9% and obesity in 5,6 % of the children. Obese children consume less often a breakfast and less milk than that normal weight children and eat more often high fat, high carbohydrates foods. Mean caloric intakes are similar. Meals and snacking take often place while watching television. Energy percent derived from proteins but not their absolute amount and fat intakes are higher in overweight children. Most of the overweight children (78 %) do not practice any sport activity. Fat intake adjusted on energy intake is positively correlated with sport duration.This preliminary study suggest that childhood obesity is now a public health threat in Algeria.     

Hereditary complement deficiency in Tunisian adults with purulent meningitis

Inherited complement deficiency is a rare disease. It predisposes to autoimmune diseases, glomerulonephritis, angioedema, and meningococcal meningitis. A prospective study was conducted over five years. The goal was to evaluate the prevalence of deficiency in Tunisian patients presenting with community acquired purulent meningitis and identify the type of deficiency. We enrolled 122 patients, 15 of whom presented with a complement deficiency (12.3%). This prevalence was higher than the one observed in the global Tunisian population and in reported international data. The mean age of deficient patients (13 men and two women) was 24.7 years.     

Place du diététicien dans l’équipe de soutien nutritionnel : évolution d’une profession

Recognised 30 years ago, hospital nutritional depletion remains a major problem of public health which concerns from 30% to 50% of all patients at admission. The circular DHOS/E 1 n? 2002-186 of the 29 March 2002, recommending the implementation of both the committee for food-nutrition (CLAN: Comité de Liaison Alimentation Nutrition) and the nutrition support team within the hospital, is the result of 10 years effort in regard to food-nutrition and the accreditation process in health care. The dietician, previously accountable for the quality of food and dietary services, has now the opportunity to play a leading role within the nutritional care team for the screening and treatment of nutritional depletion. However, the initial training and the present status of the dietician don’t allow him to follow this evolution effectively. Updating of his training and the redefinition of his missions seem indispensable to respond to today's health care needs. This will help to ensure that above legal recommendation can be applied.     

La publicité, quel impact sur l’alimentation de l’enfant ?

Advertisements who target children pose a real problem in health and ethical terms given the current context of the rise of obesity levels. The solutions open to legislators are, however, far from clear as highlighted by the results of research undertaken in various countries. The options tested range from a total ban of the messages to a stiffer monitoring of their contents. This article tries to shed light on the current debate and emphasizes the role that food culture can play in this context.     

Complément alimentaire, alicament, médicament : Qui est qui ? Ou faust revisité

Nutraceuticals are nutrients displaying drug properties. They do not have legal status and are wrongly considered as a sub-group of nutrient supplements. The difference between nutrient supplements, nutraceuticals and drugs is based on claims, dosage and the packaging of the product. The increasing use of nutraceuticals in western countries is a major health concern.     

Managing the risk of wound tetanus in family practice

Objectives

The study objectives were to assess how GPs manage the risk of tetanus in wounds, compared to the French Health Ministry guidelines on tetanus toxoid vaccination and immunoglobulin injections.

Design

A cross-sectional survey was made using an online questionnaire sent to 3,165 GPs in the French Rhône-Alpes region.

Results

The answer rate was 9.1%. Overall, 64.4% of GP complied to recommendations. The best observance was noted for minor risk wounds and for patients whose last booster vaccination was less than 5 years old (P < 0.05). Generally, GPs underused tetanus toxoid vaccination (−17.1%) and overused immunoglobulin injections (+37.1%). The main difficulties encountered were assessing the patient and his wound, misuse of immunoglobulin injections, and ignorance of recommendations.

Conclusions

The higher the tetanic risk, the less recommendations were observed. A quick diagnostic test and a better availability of new easier to memorize recommendations should help GPs optimize their practices.     

Évaluation nutritionnelle chez le dialysé

Malnutrition is common among patients with end stage renal disease treated by hemodialysis or peritoneal dialysis. It is a major cause of morbidity and mortality. Nutritional status may be assessed by several clinical markers including dietary records, anthropometric measurements and subjective global assessment. Among biochemical parameters, albumin is the most commonly examined nutritional index and transthyretin the most useful. Protein catabolic rate reflects dietary protein intake. Body composition analysis by bioelectrical impedance analysis or better by dual energy X-ray absorptiometry offers a reasonable estimation of body compartments such as total body water, fat mass and lean body mass. Periodic assessment of nutritional status must take into account the limitations of all the criteria used.     

Monitoring vancomycin in an intensive care unit: A retrospective survey on 66 patients

Objectives

The study objectives were to check whether recommended vancomycin doses were related to pharmacological objectives for intensive care patients: steady-state plasma concentration (SSc) and ratio SSc/MIC (Minimal Inhibiting Concentration). The authors tried to identify variability factors for vancomycin plasmatic concentrations at peak.

Patients and methods

This monocentric, observational, and retrospective survey was performed on 66 intensive care patients treated by antibiotics including vancomycin, alone or in combination, as a curative treatment for a severe infection with Gram-positive bacteria. Vancomycin was dosed at 15 mg/kg during the first hour, then 40 to 60 mg/kg per 24 hour. Vancomycin SSc and bacteria MIC were recorded. The SSc/MIC ratio was determined and was considered efficient when superior to 8.

Results

Forty-two percent of vancomycin SSc were within the effectiveness rate. Twenty-three percent of SSc/MIC ratios were superior to 8. The rate of clinical recovery was 71 %. The length of antibiotherapy was identified as positively interacting with biological effectiveness, unlike severe sepsis, a factor of negative interaction on vancomycin SSc in this study.

Conclusion

Less than half of the SSc and less than a quarter of the SSc/MIC ratios were at effective rates in our study. Therefore, adequacy between dosage, administration, and monitoring should be reviewed.     

Ertapénem intraveineux ou sous-cutané pour le traitement des infections urinaires à entérobactérie sécrétrice de BLSE

Introduction

Ertapenem could be used to treat urinary tract infections (UTI) caused by ESBL producing enterobacteriacae (ESBL-E) and administered subcutaneously.

Method

The authors made a retrospective study on adult patients treated with ertapenem administered intravenously or subcutaneously for UTI caused by ESBL-E, between May 2009 and August 2011 at the Chambery hospital, France.

Results

Twenty-five patients were treated (13 cases of prostatitis, ten of pyelonephritis, two of cystitis) mostly caused by Escherichia coli (24 cases). Subcutaneous injections were administered to 20 patients and 23 were treated through outpatient parenteral antibiotic therapy (OPAT). All patients were cured at the end of the ertapenem therapy. Urine samples collected during treatment for 12 patients were sterile. Three months after the end of the treatment, five patients had relapsed, and six had developed a UTI caused by another bacteria.

Conclusion

Ertapenem administered intravenously or subcutaneously could be an effective treatment for UTI caused by ESBL-E, especially using OPAT.