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Hôpital-Camfrout, France

Bouillanne O.,Service de gerontologie 2 | Bouillanne O.,University of Paris Descartes | Curis E.,University of Paris Descartes | Hamon-Vilcot B.,Service de gerontologie 2 | And 7 more authors.
Clinical Nutrition | Year: 2013

Background & aims: Aging is associated with a blunted anabolic response to dietary intake, possibly related to a decrease in systemically available amino acids (AAs), which in turn may stem from increased splanchnic AA metabolism. This splanchnic sequestration can be saturated by pulse feeding (80% of daily protein intake in a single meal), enabling increased protein synthesis. This study aimed to evaluate the efficacy of a new nutritional strategy, termed protein pulse feeding. Methods: This prospective randomized study (ClinicalTrials.gov registration number NCT00135590) enrolled 66 elderly malnourished or at-risk patients in an inpatient rehabilitation unit. All were given a controlled diet for 6 weeks. In a spread diet (SD) group (n = 36), dietary protein was spread over the four daily meals. In a pulse diet (PD) group (n = 30), 72% of dietary protein (1.31 g/kg weight/d on average) was consumed in one meal at noon. The patients were evaluated at admission and at 6 weeks for body composition [lean mass (LM), appendicular skeletal muscle mass (ASMM), and body cell mass (BCM) indices, measured by X-ray absorptiometry combined with bioelectrical impedance analysis] (primary outcome), hand grip strength, and activities of daily living (ADL) score. Results: Protein pulse feeding was significantly more efficacious than protein spread feeding in improving LM index (mean changes from baseline for PD group: +0.38 kg/m2; 95% confidence interval (CI), [0; 0.60]; for SD group: -0.21 kg/m2; 95% CI, [-0.61; 0.20]; p = 0.005 between the two groups), ASMM index (+0.21 kg/m2; 95% CI, [0; 0.34] and -0.11 kg/m2; 95% CI, [-0.20; 0.09]; p = 0.022), BCM index (+0.44 kg/m2; 95% CI, [0.08; 0.52] and -0.04 kg/m2; 95% CI, [-0.09; 0.10]; p = 0.004). There was no significant effect for hand-grip strength or ADL score. Conclusions: This study demonstrates for the first time that protein pulse feeding has a positive, clinically relevant effect on lean mass in malnourished and at-risk hospitalized elderly patients. © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.

Perisse A.,Service de reanimation | Sahuc P.,Service de Neurologie | Wybrecht D.,Service de Neurologie | Joubert C.,Service de Neurochirurgie | And 5 more authors.
Revue de Medecine Interne | Year: 2014

Introduction: Acute cytomegalovirus (CMV) infection increases the risk of vascular thrombosis but reports of cerebral venous thrombosis are rare. Case report: We report a 36-year-old woman who presented with a cerebral venous thrombosis and acute CMV infection heralded by a cytolytic hepatitis. Heterozygous factor V Leiden mutation was also identified. The patient was treated with anticoagulation for 1. year with favourable outcome. Conclusion: Serologic tests for CMV infection should be performed in case of cerebral venous thrombosis with liver cytolysis or flu-like symptoms. CMV infection often triggers thrombosis in combination with other inherited or genetic predisposing risk factors that should always be searched. © 2013 Société nationale française de médecine interne (SNFMI).

Boumahni B.,Service de reanimation neonatale et pediatrique | Kaplan C.,Sanguine | Clabe A.,Service de Biologie | Randrianaivo H.,Unite de medecine foetale et genetique | Lanza F.,French Institute of Health and Medical Research
Archives de Pediatrie | Year: 2011

Neonatal thrombocytopenia may stem from several origins. A newborn was hospitalized on the 3rd day of life with thrombocytopenia likely due to maternofetal autoimmune thrombocytopenia. Two days later, he displayed a chikungunya virus infection, during a severe epidemic on Reunion Island. The characterization of human platelet antigen (HPA) in the parents showed incompatibility in the HPA-3 system; however, no detectable antiHPA-3a antibody was found in the mother's serum. The persistence of moderate thrombocytopenia led to the diagnosis, using flow cytometry, of Bernard-Soulier syndrome (BSS), with no detectable GPIbIX. This case shows that neonatal inherited thrombocytopenia may be difficult to characterize, especially when it is associated with an acquired cause. © 2010 Elsevier Masson SAS.

Landre-Peigne C.,Service de pediatrie | Ka A.S.,Service de pediatrie | Peigne V.,Service de Reanimation medicale | Bougere J.,Service de Biologie | And 2 more authors.
Journal of Hospital Infection | Year: 2011

Neonatal nosocomial infections are public health threats in the developing world, and successful interventions are rarely reported. A before-and-after study was conducted in the neonatal unit of the Hôpital Principal de Dakar, Senegal to assess the efficacy of a multi-faceted hospital infection control programme implemented from March to May 2005. The interventions included clustering of nursing care, a simple algorithm for empirical therapy of suspected early-onset sepsis, minimal invasive care and promotion of early discharge of neonates. Data on nosocomial bloodstream infections, mortality, bacterial resistance and antibiotic use were collected before and after implementation of the infection control programme. One hundred and twenty-five infants were admitted immediately before the programme (Period 1, January-February 2005) and 148 infants were admitted immediately after the programme (Period 2, June-July 2005). The two groups of infants were comparable in terms of reason for admission and birth weight. After implementation of the infection control programme, the overall rate of nosocomial bloodstream infections decreased from 8.8% to 2.0% (P= 0.01), and the rate of nosocomial bloodstream infections/patient-day decreased from 10.9 to 2.9/1000 patient-days (P= 0.03). Overall mortality rates did not differ significantly. The proportion of neonates who received antimicrobial therapy for suspected early-onset sepsis decreased significantly from 100% to 51% of at-risk infants (P< 0.001). The incidence of drug-resistant bacteria was significantly lower after implementation of the programme (79% vs 12%; P< 0.001), and remained low one year later. In this neonatal unit, simple, low-cost and sustainable interventions led to the control of a high incidence of bacterial nosocomial bloodstream infections, and the efficacy of these interventions was long-lasting. Such interventions could be extended to other low-income countries. © 2011 The Healthcare Infection Society.

Malfuson J.V.,Service dHematologie Clinique | Konopacki J.,Service dHematologie Clinique | Thepenier C.,Sanguine | Eddou H.,Service dHematologie Clinique | And 2 more authors.
Annals of Hematology | Year: 2012

Current salvage therapies for relapsed acute myeloid leukemia (AML) are unsatisfactory. We retrospectively evaluated the efficacy and toxicity of fractionated doses of gemtuzumab ozogamicin (GO) combined with a standard 3+7 induction regimen in young patients with AML in first relapse. Salvage regimen consisted of GO 3 mg/m2 on days 1, 4, and 7; cytarabine, 200 mg/m2 on days 1-7; and daunorubicine, 60 mg/m2; or idarubicine, 12 mg/m2 on days 1- 3. Fourteen patients were treated between April 2008 and April 2011. Median age was 46 years (29-58), median white blood cell count is 3.4 109/L (0.9-19), and median first complete remission (CR) duration is 11 months (1-42). All the patients had previously received high or intermediate doses of cytarabine as consolidation therapy. Salvage treatment was performed as scheduled for the 14 patients, using daunorubicine in 12 patients and idarubicine in two. Overall response rate was 79 % with six CR and five CR with incomplete platelet recovery. Median times to neutrophil (>0.5 109/L) and platelet (>20 109/L) recovery were 29 days (23-32) and 36 days (28-48), respectively. Allogeneic transplantation was performed in the 11 responding patients within a median time of 4 months (3-10). Three mild and one moderate veno-occlusive disease (VOD) occurred after salvage and two moderate VOD after transplantation. Median and 2-year overall survival (OS) were 10 months and 42 %, respectively. For responders, estimated 2-year OS was 53 % (median OS not reached). This salvage regimen seems safe and effective in younger patients with AML in first relapse allowing allogeneic transplantation in CR2 for most patients. © 2012 Springer-Verlag.

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